November 9, 2023
Avoid Submitting Duplicate Redeterminations
As a Medicare provider, at times your billing practices are reviewed by other CMS contractors/programs such as:
- Recovery Audit Contractor (RAC),
- Comprehensive Error Rate Testing (CERT),
- Office of Inspector General (OIG)
- Supplemental Medical Review Contractor (SMRC).
If errors are found, you will receive requests to repay the monies paid for the reviewed service(s). If you disagree with the overpayment request, you have appeal rights and may submit a request for Redetermination.
The preferred method to send a Redetermination is through the myCGS web portal. Instructions are available in the myCGS User Manual.
Before sending a Redetermination, please wait until you receive your demand for recoupment letter from CGS Administrators. That will ensure the case is final and we are able to process the appeal request in a timely manner.
Also, we’ve seen an increase in duplicate Redetermination requests of this nature. Please keep in mind CGS has 60 days to process Redeterminations. Sending multiple requests for the same claim cause additional delays in processing this workload. To ensure duplicate requests are not sent, always check the status of your appeal requests either through myCGS or the Interactive Voice Response (IVR) system.
Refer to Appeals/Redeterminations (cgsmedicare.com) for helpful resources and additional instructions.