Health Law Firm | Medicare Recovery Audit Contractors
Pennsylvania Medicare Attorney
The Martin Law Firm is a health law firm located in Blue Bell, Pennsylvania. We represent health care providers throughout the U.S. for Medicare audits and Medicare appeals. Attorney Jason B. Martin is a skilled and experienced health care attorney that can analyze your case and assist you in preparing an effective defense to claim denials from Medicare contractors.
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What is a Recovery Audit Contractor (RAC)?
The Medicare Modernization Act and the Tax Relief and Healthcare Act of 2006 gave rise to the Recovery Audit Contractor. The RAC mission is to detect and correct past improper payments utilizing the audit or post-payment review process. Generally, RACs perform two types of reviews, automated and complex. Complex reviews require the review of medical records and automated reviews do not. Any provider who bills fee-for-service programs can be subject to reviews by RACs
How is the RAC paid?
The RAC is paid on a contingency basis, which necessarily gives rise to aggressiveness in their pursuit of recoupment.
What is the review process?
RACs may attempt to identify improper payments resulting from incorrect payments; non-covered services; incorrectly coded services; and duplicative services. Following an overpayment determination, a demand letter is issued by the RAC. The RAC will offer an opportunity for the provider to discuss the improper payment determination which is outside the normal Medicare appeals process. Issues reviewed by the RAC will be approved by CMS prior to widespread review. The RAC will pursue recovery attempts for the overpayment.
What are the health care provider's options?
If a demand is made, the provider can pay by check, allow for recoupment from future payments, request or apply for extended payments or appeal through the Medicare appeals process.
As with any post payment review, providers should take preventive action. At a minimum, providers should know where previous improper payments have been found; know if they are submitting claims with improper payments; and should prepare to respond to RAC documentation requests. Providers should take more proactive approaches to compliance by implementing a health care compliance program for their practice.
Skilled Legal Representation for Health Care Providers
The Martin Law Firm has successfully defended many Medicare and third party payor audits and has developed many successful strategies for reducing Medicare overpayment demands. Contact The Martin Law Firm for a free case evaluation or to speak to an experienced attorney to take immediate preventive action.
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