Recoupment
Recoupment is a payer taking back money it already paid you — often by offsetting it against future payments — after deciding a prior claim was overpaid; the underlying determination is frequently disputable.
Recoupment is when a payer reclaims money it previously paid, having decided after the fact that the claim was overpaid, not covered, or paid in error. It commonly happens through offset: rather than sending you a bill, the payer withholds the recouped amount from your next remittance, so a payment you're expecting simply arrives smaller, with an adjustment explaining the takeback. Recoupments come from post-payment audits, retroactive eligibility changes, coordination-of-benefits corrections, and payer 'overpayment' determinations. Two things make them worth understanding. First, they hit cash you already counted, so an unexpected offset can quietly distort your A/R and your deposits if you're not reconciling the takeback to the specific original claim. Second, the determination behind a recoupment is often disputable — a claimed overpayment can rest on a coding interpretation, an eligibility record, or an audit finding that's wrong, and payers generally must give you notice and appeal rights before or shortly after recouping. So a recoupment isn't automatically final money lost; where the original claim was actually correct, the recoupment itself can be appealed. The risk is letting offsets pass unexamined, because a takeback buried in a larger remit is easy to miss entirely.
Volari reconciles payer offsets to the original claims and challenges recoupments built on a wrong coding or eligibility determination — the takebacks that pass unexamined inside a larger remit.
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