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Medicare Compliance & Reimbursement

RAC MANAGEMENT:

RAC Appeals Target Misuse of Approved Reviews, Unfair Recoupment Amounts

Published on Wed Feb 17, 2010

Find out how rehab providers and a DME company are fighting back. Some providers aren't taking what they view as unfair RAC denials lying down. Case in point: In Florida, "providers have had Part B rehab therapy claims denied because claims had two untimed codes appearing on the same claim," says Nancy Beckley, MB, MBA, CHC, a consultant with Bloomingdale Consulting Group Inc. in Brandon, Fla. The problem: "There is no prohibition against billing two untimed codes -- the approved [RAC] issue is for two units of an untimed code," says Beckley. And, "Florida providers are appealing that issue because it represents a misinterpretation of untimed codes by the RACs. An example would be a speech swallowing evaluation and a speech swallowing service on the same claim." Also: A durable medical equipment company is appealing a RAC recoupment involving what the RAC claims to be noncompliant billing for a power wheelchair. [...]
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