What is a Medicare Reopening

June 3, 2014
Rick Gawenda

A reopening is a remedial action taken to change a final determination or decision that resulted in either an overpayment or an underpayment, even though the determination was correct based on the evidence of the record. Reopenings are separate and distinct from the Medicare appeals process. Section 937 of the Medicare Modernization Act (MMA) required the Centers for Medicare and Medicaid Services (CMS) to establish a process whereby providers, physicians, and suppliers could correct minor error or omissions outside of the appeals process. CMS defines clerical errors (including minor errors or omissions) as human or mechanical errors on the part of the party or contractor, such as:

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