Recoupment
A payer's withholding of current claim payments to offset prior overpayments.
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
CMS allows recoupment after a notice period. Practices can appeal the underlying determination; appeal during certain Medicare stages stays the recoupment.
How it shows up in your practice
When a recoupment notice arrives, log the dates, project the cash-flow impact, and decide on appeal vs. acceptance quickly.
Sources
- CMS — Recovery Audit Programhttps://www.cms.gov/medicare/audits-compliance/recovery-audit-program
Track recoupments in the Denial Workbench
Open denial workbench →Related terms
- Denials & AppealsRecovery Audit Contractor (RAC)CMS contractors who identify and recover improper Medicare payments through review of paid claims.
- Compliance Program60-Day Overpayment RuleACA requirement that Medicare and Medicaid overpayments be reported and returned within 60 days of identification.
- Denials & AppealsMedicare Appeals LevelsThe five-level Medicare appeals process: Redetermination, Reconsideration, ALJ Hearing, Medicare Appeals Council, and Federal District Court.
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
- GlossaryRecovery Audit Contractor (RAC)CMS contractors who identify and recover improper Medicare payments through review of paid claims.
- GlossaryMedicare Appeals LevelsThe five-level Medicare appeals process: Redetermination, Reconsideration, ALJ Hearing, Medicare Appeals Council, and Federal District Court.
- Glossary60-Day Overpayment RuleACA requirement that Medicare and Medicaid overpayments be reported and returned within 60 days of identification.
- 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.
- GlossaryPost-Payment ReviewPayer review of paid claims after the fact, often resulting in overpayment determinations and recoupment.
- GlossaryPre-Payment ReviewPayer review of selected claims before payment, requiring submission of supporting documentation.
- 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.
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.