You got an SNF Medicare recoupment notice. Here's the defense.

Understanding the recoupment basis

Read the audit notice carefully. Identify the specific claim universe, the specific findings, and the basis for recoupment. Different findings need different defenses: case-mix challenges need MDS documentation review; level-of-care challenges need clinical narrative; qualifying stay challenges need hospital records.

Documentation pull priority

Pull MDS assessments + supporting clinical documentation for sample claims. Identify any documentation that supports the case-mix assignment beyond what was submitted. Document any clinical narrative that strengthens the case.

Appeal strategy

Initial Level: redetermination with the MAC. Level 2: reconsideration with the QIC. Level 3: ALJ hearing (most successful level for SNF appeals. averages 60-70 percent reversal). Build documentation through each level, don't waste your best evidence at Level 1.

Triple-check process improvement

Recoupments often expose systemic triple-check failures. Strengthen the pre-billing triple-check (clinical, billing, MDS reconciliation) to prevent future findings. Document the process improvement as audit defense for future scrutiny.

Cash flow management during appeal

Recoupments offset current Medicare payments. Plan cash forecast accordingly. Negotiate payment plans where appropriate. Don't let the recoupment trigger a cash crisis that compounds the audit pressure.

Free SNF Medicare audit defense consultation

Same-week consultation for active SNF Medicare recoupment notifications. Senior partner walks the specific findings + recommends defense strategy + identifies appeal-stage prioritization.