The Doctor is Deployed - LLM Publications

RAC, cont.coverage, coding or billing policies andcannot develop their own standards.What is my recourse if I amassessed an overpayment thatI do not believe is owed?During the demonstration periodand as the program has rolled outacross the country, many providershave appealed overpaymentfindings. Pay close attention tothe timeframes discussed below;they are critical to a successfulappeal. While it is not required bylaw, the OMA recommends that allappeal communications be done bycertified registered mail to ensuredocumentation of the dates that appealrequests are sent and received.15 Day Rebuttal Period. Contactthe RAC within 15 days of the dateof the demand letter to discuss theoverpayment determination. Rememberthat this discussion does not qualifyas a formal appeal and the timeframesdiscussed below continue to run.Formal Appeal Steps1. Redetermination. Appeal to thefiscal intermediary within 120 days ofthe RAC’s initial decision. The FIwill have 60 days to determine if theRAC findings should be sustained.Make this appeal within 30 daysto avoid recoupment of theoverpayment. Note that the appealmust be received and date stampedwithin 30 days, not just postmarked.2. Reconsideration. Submit arequest for reconsideration tothe Qualified IndependentContractor within 180 days ofthe redetermination decision. InOregon, the Qualified IndependentContractor is First Coast ServiceOptions, Inc. The QIC has 60 daysto make a decision.Note that the RAC will beginrecoupment of the overpayment 60days after the initial redeterminationdecision unless the physician firstsubmits a request for reconsideration.3. Administrative Law Judge Hearing:File request within 60 days ofreceipt of reconsideration decision.The ALJ must issue a writtenopinion within 90 days of the datethe hearing request is received.Minimum amount in dispute: $1204. Medicare Appeals Council.Appeal to Departmental AppealsBoard within 60 days of notice of theALJ’s decision.5. Federal Court Review. Filewithin 60 days of receipt of theDepartmental Appeals Boarddecision. Minimum amount indispute: $1,130.When and how will the RACtake the money back?The RAC will first request that thephysician provide a refund of theoverpayment. If the physician isunable to provide a complete refund,a repayment plan can be createdto repay the amount over time. If aphysician does not repay the amountowing within 30 days, interest willaccrue going back to the date of thedemand letter. After 40 days, Medicarewill begin withholding amounts fromcurrent and future claims until the fulloverpayment plus interest is recouped,or an extended payment plan isimplemented.How toContact HDIPHONE(866) 376-2319FAX(702) 240-5510E-MAILracinfo@emailhdi.comADDRESS7501 Trinity Peak StSuite 210Las Vegas, NV 89128Physicians may stop recoupment of anoverpayment at several points in theprocess:99Send a request for redeterminationwithin 30 days of the date on thedemand letter99If the redetermination is notfavorable, send a request forreconsideration within 60 days ofthe redetermination finding.What steps should I be takingnow to get ready for a RAC audit?99Identify a person to be primarilyresponsible for responding to theRAC.99Go to the HDI website to give themthe primary contact person for yourclinic.99Be watchful for RAC demandletters. For an example of thedemand letter, go to the RACwebsite at www.healthdatainsights.com.If the letter is not yet posted, expectit soon.99Develop a tracking system forresponding to the RAC andappealing any overpayments.99Review existing charting to ensureare coding/documenting correctly.99Review available data to identify anypatterns of errors. •OMA is Here to HelpAttend the upcoming OMA Recovery Audit Contractor EducationalWebinar scheduled for May 12 from 1:30–3pm.The webinar will cover:• RAC: The basics• The CMS approved issues up for RAC review• How to respond to a RAC audit: appeals and recoupment• One physician’s experience with a RAC auditTo register, please contact Jenn Webster at the OMA at (503) 619-8000.You can also contact Gwen Dayton, JD, OMA General Counsel, withquestions or concerns about the RAC program or interactions with theRAC. Reach her at gwen@theoma.org or (503) 619-8117.26 • Medicine in Oregon