Wiki RAC question

[mprysock]

Have received a couple of recovery requests from my Medicare carrier's RAC. If the coding error was a missing modifier and we are within the year of timely filing, can we appeal the recovery and submit a corrected claim to keep the payment?? I went to a seminar back in March and the guy confused me. He made it sound like we could appeal the coding errors vs. refunding the carrier. Anyone have expert knowledge of the RAC process and what the provider rights are??

 

[acbarnes]

I would be interested to know this answer too. We had a RAC audit that revealed one of the providers billed a 99203 (new pt E/M) which should have been a 99214 b/c the patient was seen as a Hospital consult 2 days before they came in the office for the first time. I am considering doing a redermination notice as a corrected claim. Does anyone have any experience with this? Still researching.....

Anna Barnes, CPC, CEMC

 

[tmerickson]

You need to refund the money to the RAC first. Then you have a limited time to appeal their decision, through them. Your best bet is to get on their website, and look over their appeal process. They are usually long and very detailed, and you want to follow it to the "T". Good luck!