Home Health & Hospice Week

Don't forget the Discussion Period option.

If you receive a denial from the Recovery Audit Contractor when it reviews your claim under the newly approved home health audit topic, all is not lost.

"Appeal every denial," emphasizes finance expert Tom Boyd with Simione Healthcare Consultants in Rohnert Park, California. Remember, the Centers for Medicare & Medicaid Services grades RACs on how many overturned denials they rack up (see story, p. 42).

First step: Before you file a formal appeal, you can request a "discussion period" from the RAC.

"You are encouraged to file a Discussion prior to an Appeal," Performant said in a webinar for providers given last year. "This gives the RAC the opportunity to evaluate the original determination."

Using the Discussion option "lessens the administrative burden for both you and your Medicare Administrative Contractor," Performant said.

Providers have 30 calendar days from the RAC determination to submit a request for a Discussion Period, the National Association for Home Care & Hospice says in its provider newsletter. The 30-day period begins from the date of the Review Results letter. The RAC has 30 days from receipt of the Discussion Period request to respond to the provider.

If you do decide to move forward with a formal appeal, it goes through the usual process via your Medicare Administrative Contractor, Performant noted.

Option: Consider appealing with outside expert help from a consultant, Boyd urges.