If I disagree with an RAC’s overpayment findings, can I appeal?

Yes. Physicians are provided the same rights to appeal an RAC finding of overpayment as claim denials by the Medicare contractor. Physicians may also choose to send a rebuttal of the findings directly to the RAC within 15 days of receiving the RAC’s letter identifying an overpayment. Note, however, that this does not stop the clock on the 120 day time period during which you can request a redetermination (first level appeal) from your Medicare contractor or on the interest accrued when money is not refunded within 30 days of request. Physicians who choose to send a rebuttal to the RAC will want to either simultaneously file a request for redetermination to the Medicare contractor or carefully track the status of the rebuttal and be prepared to file the request for redetermination within the 120 time period, if needed.

Your rebuttal letter or request for redetermination should reference Medicare policy, statute, or information from the medical record documentation that refutes the reason for denial.

During the RAC demonstration project, 35.1% of appealed Part B claims resulted in rulings in favor of the physician or provider according to a report (8-page PDF file; About PDFs) issued by the Centers for Medicare & Medicaid Services in January 2009. The percentage of rulings in favor of the physician or provider by individual RAC were significantly higher for two RAC’s in the demonstration project at 62.2% and 43.8%.

To learn more about the Medicare appeals process, see the Medlearn Matters brochure, The Medicare Appeals Process (2-page PDF file; About PDFs).