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Medicare Compliance & Reimbursement

Recovery Audit Contractors:

Don't Rack Up Unfair RAC Denials: Follow These 6 Rules for Appealing Payment Recoups

Published on Fri Mar 26, 2010

Even if you're wrong on an issue, check out this often overlooked escape hatch. RAC denials can be disheartening, but before you proceed with an appeal, check out these potential pitfalls and tips for winning. Rule No. 1: Know who you are up against. "RACs aren't likely to deny anything where they don't believe they have say a 90 percent chance of recovering money," says Pauline Franko, MSCP, PT, principal of Encompass Consulting & Education in Tamarac, Fla. And, "you can figure the RAC is going to fight tooth and nail to make sure a denied claim stays denied upon appeal," says Victor Kintz, MBA, CHC, LNHA, RACCT,CCA, managing director of operations for the Polaris Group based in Tampa, Fla. That's because "the outcome will affect whether or not they will be paid for the work done on that claim." Rule No. 2: If you think you're right, fight. Providers [...]
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