Medicare Compliance & Reimbursement

These examples show how you may be able to recoup part of your denied claim, even if you have to give up a portion of the reimbursement. Some providers aren't taking what they view as unfair RAC denials lying down. Case in point: A durable medical equipment company is appealing a Recovery Audit Contractor recoupment involving what the RAC claims to be noncompliant billing for a power wheelchair. The billing allegedly violated some bundling rules that are part of a local coverage decision, reports attorney Amy Fehn, whose law firm is handling the appeal for the DME provider. "The issue involves armrests," Fehn explains. The local coverage determination (LCD) policy "has a chart saying if you are providing this code and this code, they should be bundled with a certain other code." The guidance, however, on the bundling issue isn't very clear, she adds. And, "even if there is an [...]