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Wiki Rac demand letters

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Dawn

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Can anybody help me please I am confused.

Are you to refund the requested money to Mcare & then do your redetermination or can you do the redetermination within 30days of the letter?

I was also told by a customer rep on Mcare hotline that if you don't do the refund you should mark on the redetermination form "please stop the over pmt request until redetermination is completed". Has anybody have any suggestions?

Thanks,

Dawn H, CPC
 
A redetermination is the first level of appeal. A provider may request a redetermination when they are dissatisfied with the overpayment decision. A redetermination must be submitted within 30 days to prevent offset on day 41. You will always contact the contractor/MAC for this option. The timeframe is between day 1 and 120 upon receipt of the demand letter. It must be submitted within 120 days of receipt of demand letter. To prevent offset on day 41 the Redetermination must be filed within 30 days. The timeframe ends on day 120.

http://questions.cms.hhs.gov/app/answers/detail/a_id/9994/kw/rac/session/L3NpZC9MU1BXak43aw==

Below is the link to the RAC website. MLN The Medicare Appeals Process Brochure explains the process in greater detail (found towards the bottom of the page)

http://www.cms.gov/RAC/
 
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