ANSWERS · COMPLIANCE

How do I appeal a Medicare overpayment or extrapolated demand?

You appeal a Medicare overpayment through the five-level appeals process, starting with a redetermination filed within the deadline, and you specifically challenge extrapolation when a small sample is projected across many claims. Extrapolated demands are frequently reduced when the sample size or statistical method is contested.

Practice OwnerBilling Lead

Step by step

1
File the redetermination on time
Request within 30 days to pause recoupment (the full window is 120 days).
2
Document every sampled claim
Provide the records that support each claim in the sample.
3
Challenge the extrapolation
Contest the sample size, methodology, and the universe of claims — this is where large demands shrink.
4
Escalate through the levels
Reconsideration, then ALJ, where many overpayments are reduced; consider a statistician for big extrapolations.

Common questions

Can you stop Medicare from recouping during an appeal?

Yes. Filing the first two appeal levels within the specified windows generally pauses recoupment until the appeal is decided.

Where Volari fits: Volari's file-only-what's-substantiated discipline is the same posture that keeps a practice clean under Medicare scrutiny.

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