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Linda Collins Blogger

How to Keep Your Money!

Posted by Linda Collins | January 08, 2016

A confusing but important part of the RAC audit process involves appeal deadlines. The bottom line: if you notify the Medicare Administrative Contractor responsible for reviewing a RAC denial, you can keep all of the money in dispute pending final resolution of the issue. Here’s how it works in practice.

  1. You get audited. The RAC determines that you have received an overpayment. Your MAC will send you a demand letter stating the amount of overpayment and requesting payment from you within 30 days.

  2. If you choose to appeal, Medicare gives you 120 days to file your redetermination (i.e., first-level appeal).

  3. But if you simply notify the MAC within 30 days of the date of the demand letter that you intend to appeal, you can avoid Medicare automatically recouping the amounts at issue. If you fail to provide this notice within 30 days – your request must be date-stamped and in the MAC’s mailroom within 30 days of the date on the demand letter – Medicare will recoup the overpayment by offsetting against current claims you’re filing.

  4. A slightly different process applies if you then file a second-level appeal (“reconsideration”). While you have 180 days to file the reconsideration, you must submit it within 60 days to again avoid recoupment.

To find additional information about the Medicare overpayment collection process, refer to Chapter 34 of the “Medicare Claims Processing Manual” (Publication 100-04) and Chapters 3 and 4 of the “Medicare Financial Management Manual” (Publication 100-06) located at on the CMS website.

Remember – time in this case truly is money.

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