Yes. Physicians are provided the same rights to appeal a RAC finding of overpayment as a claim denial by the Medicare contractor. There are actually several options for responding to an unfavorable RAC review, and it may benefit physicians to take advantage of more than one.
Initial information about the RAC rebuttal and discussion processes confused these terms. To clarify this, the Centers for Medicare and Medicaid Web site includes a frequently asked question section that provides the following information.
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If I disagree with an RAC's overpayment findings, can I appeal?
- The discussion period offers the opportunity for the provider to provide additional information to the RAC to indicate why recoupment should not be initiated. It also offers the opportunity for the RAC to explain the rationale for the overpayment decision. After reviewing the additional documentation submitted, the RAC could decide to reverse their decision. A letter will go to the provider detailing the outcome of the discussion period. You always contact the RAC for this option. The time frame is between day 1 and day 40 and will begin with receipt of the demand letter for automated review and from receipt of the review results letter for complex review. The time frame ends on day 40. Offset will occur on day 41.
- The rebuttal process allows the provider the opportunity to provide a statement and accompanying evidence indicating why the overpayment action will cause a financial hardship and should not take place. A rebuttal is not intended to review supporting medical documentation nor disagreement with the overpayment decision. A rebuttal should not duplicate the redetermination process. You will always contact the contractor/MAC for this option. The time frame is between day 1 and day 15 from the date of the demand letter. The time frame ends on day 15.
- 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 time frame is between day 1 and day 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 time frame ends on day 120.
To learn more about the Medicare appeals process, see the Medlearn Matters brochure, The Medicare Appeals Process (2-page PDF file; About PDFs).
Recovery Audit Contractors
RAC Scopes and Jurisdictions
Where can I learn what issues the RAC is reviewing?
Whose claims can be reviewed by the RAC?
Aren’t RACs focusing on hospital claims?
Do RACs review claims paid by Medicare Advantage Managed Care plans?
How far back can RACs look in reviewing claims?
Will RACs review claims for evaluation and management services?
RAC Review Criteria
How will RACs review claims for overpayments and underpayments?
RAC Recovery Requests
How can I identify a RAC recovery versus a request for refund from other sources?
If I disagree with an RAC's overpayment findings, can I appeal?
Is there limitation on recovery of small overpayments found by the RAC?
Medical Record Review by the RAC
Must I allow the RAC to conduct an on-site review of my medical records?
Planning to Avoid RAC Issues
What should I do to protect my practice from RAC recovery efforts?
