If you aren't used to dealing with recovery audit contractor (RAC) requests, you're not alone -- but a new CMS Q&A could help you clarify what to do when you receive one. On July 16, CMS updated a RAC Q&A on its Web site, shedding light on the differences between the RAC discussion period and the rebuttal and redetermination processes. Discussion period:
After the RAC reviews any additional documentation that you've submitted, it could reverse its decision, and will send you a letter "detailing the outcome of the discussion period."
Rebuttal process:
Once you receive a demand letter from a RAC, you have from one to 15 days to contact the MAC and open a rebuttal process, during which time you can submit evidence indicating why an overpayment action would cause a financial hardship and should not take place. "A rebuttal is not intended to review supporting medical documentation nor disagreement with the overpayment decision," the CMS site indicates.Redetermination:
This denotes the first level of appeal, and you should contact your MAC for a redetermination. "The timeframe is between day one and 120 upon receipt of the demand letter," the Q&A states. "It must be submitted within 120 days of receipt of demand letter. To prevent offset on day 41 the Redetermination must be filed within 30 days."To read the Q&A and find a link to a RAC chart, visit http://questions.cms.hhs.gov/app/answers/detail/a_id/9994/kw/rac.