Effective November 1, 2011, CMS is modifying the Medicare overpayment notification process to eliminate a previous notification to providers. Prior to November 1, if a provider’s outstanding balance had not been resolved, providers received three notification letters: an Initial Demand Letter, a Follow-up Letter, and an Intent to Refer Letter. Because the majority of providers respond to the Initial Demand Letter, CMS is no longer sending the Follow-up/second demand letter. If an overpayment is not paid within 90 days of the initial letter, providers will continue to receive a letter explaining CMS’s intention to refer the debt for collection. Provider appeal rights are not being changed.