Home Health & Hospice Week
When RAC reviews hit home health
When RAC reviews hit home health agencies and hospices, you'd better keep your appeals skills sharpened. Recovery Audit Contractors made overpayment determinations on nearly 600,000 claims in the three-year RAC demonstration, says an updated report about RAC appeals that CMS released in June. As of March 2009, providers had appealed 12.7 of those determinations -- more than 76,000. More than 64 percent of the appeals were successful, the report notes. That means that of all the RAC overpayment determinations, more than 8 percent were overturned on appeal. "While RACs have not announced review of home health or hospice claims, RAC actions and appeals remain of utmost concern to the home care industry," urges the National Association for Home Care & Hospice. Providers' success in getting RAC overpayments overturned is even better than the report indicates, NAHC says. "These data do not include reversals made by contractors when additional documentation was submitted, which the program characterized as clerical reopenings." Difference: In the demo, RACs received their contingency fee based on the overpayment amount as long as the appeal didn't succeed at the first level, NAHC adds. Under the permanent program, their fee is taken back no matter what level of appeal a provider succeeds at. The report is online at www.cms.gov/RAC/Downloads/DemoAppealsUpdate61410.pdf.
Home Health & Hospice Week
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