What document is sent by the Medicare Recovery Audit Contractor when incorrect payment is determined?

The document sent by the Medicare Recovery Audit Contractor (RAC) when an incorrect payment is determined is a demand letter. This letter serves as official communication notifying the provider that an overpayment has been identified and that they are required to return the excessive amount. The demand letter provides details such as the reason for the overpayment, the amount owed, and specific instructions on how to repay the amount.

The demand letter is crucial in the recovery process because it gives the healthcare provider formal documentation of the audit findings and the next steps to be undertaken. It also outlines the rights of the provider, including options for appeal if they believe the findings are incorrect.

In contrast, the audit report typically includes a summary of the findings from the audit but does not serve as a formal request for repayment. A claim adjustment notice informs a provider about changes made to a claim but does not specifically indicate an overpayment situation. An appeal form is used by the provider to contest findings or decisions but is not the initial document indicating that an overpayment must be returned.