Post-Payment Review
Payer review of paid claims after the fact, often resulting in overpayment determinations and recoupment.
1 min read · Last reviewed May 23, 2026
At a glance
- Category
- Denials & Appeals
- Primary sources
- 1
- Workspace handoff
- denial workbench →
Where this comes up
This is denial-workbench territory. A remit posts with a CARC/RARC, the biller decides whether to rebill, appeal, or write off, and the appeal packet has to cite the chart, the order, and the payer's own policy language. Recurring patterns trace back to an upstream workflow gap.
Full definition
What it is in practice
RAC, UPIC, and CERT contractors perform post-payment review. Statistical sampling and extrapolation are common in larger reviews.
How it shows up in your practice
Respond completely. Always retain audit trail, signatures, and documentation. Appeal extrapolations when the underlying sample is flawed.
Sources
- CMS — Recovery Audit Programhttps://www.cms.gov/medicare/audits-compliance/recovery-audit-program
Manage post-payment review in the Denial Workbench
Open denial workbench →Related terms
- Denials & AppealsPre-Payment ReviewPayer review of selected claims before payment, requiring submission of supporting documentation.
- Denials & AppealsRecovery Audit Contractor (RAC)CMS contractors who identify and recover improper Medicare payments through review of paid claims.
- Denials & AppealsAudit DefenseThe organized process of preparing for and responding to a payer or government audit.
- Denials & AppealsExtrapolationThe statistical projection of overpayment findings from a sample of claims to a larger universe of claims, used in many Medicare audits.
D3rx is a healthcare-billing and compliance research aid maintained by D3rx Inc. Articles are drafted by an LLM (Anthropic Claude) against primary HHS, OCR, CMS, eCFR, NIST, and state-regulator publications, and reviewed for restraint and source fidelity by the D3rx team.
Reviewer status: a named credentialed reviewer (CHC, CHPC, or healthcare attorney) is being engaged. Until that engagement is finalized, this page does not claim credentialed review.
Related across the archive
- GlossaryPre-Payment ReviewPayer review of selected claims before payment, requiring submission of supporting documentation.
- GlossaryAudit DefenseThe organized process of preparing for and responding to a payer or government audit.
- GlossaryExtrapolationThe statistical projection of overpayment findings from a sample of claims to a larger universe of claims, used in many Medicare audits.
- GlossaryRecovery Audit Contractor (RAC)CMS contractors who identify and recover improper Medicare payments through review of paid claims.
- GlossaryRAC Audit TriggerDocumentation or coding pattern that increases the likelihood of a Recovery Audit Contractor review.
- GlossaryRecoupmentA payer's withholding of current claim payments to offset prior overpayments.
- BillingHow to Appeal an Insurance Denial: Step-by-Step GuideClaim denied? Step-by-step appeal process with payer deadlines, denial code fixes, appeal letter template, and escalation options.
- BillingMedical Billing Denial Codes: What They Mean and How to Fix ThemCO-4, CO-97, CO-16, PR-96 and more. What each denial code means and exactly how to fix it.
This glossary entry is a research aid for billing and compliance staff. It does not provide legal, medical, or financial advice and does not replace counsel. References cited link to primary sources at HHS, OCR, CMS, eCFR, NIST, and the relevant payer or industry body.