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LACEY13

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I was hoping to get a little advise from people that have been audited by RAC. If we recieve a demand letter for not putting a 59 modifer with a 79 modifer on claims. It looks like there claim is legit and we did do it wrong. However does that mean that there is no fighting the outcome? We did do the services and I do believe deserve to get paid for them! Does anyone know anything about the audit process is it worth it to is to appeal? Has any one been complex audited in result to fighting maybe something that we could not win? Just a some insight if anyone has any.


Thanks,

Lacey Anderson :)
 
We have been audited on the hospital side. We have fought several and won.

The problem we are having is they take their money back before we even get notice that they think there is an overpayment. They aren't supposed to take anything back for like 45 days or something like that. We haven't had a modifier issue yet but we have had several number of units and couple of supplies that fall under the 72 hour issue. Most have been resolved with a single phone call. So I would suggest you fight it if it is correct.

Laura, CPC, CPMA, CEMC
 
These are not recent claims so there is no way to call and correct these mistakes! Unless you know something that I dont know about the audit process? After a year we can not call and correct our mistakes and now they want the money back. Did you get demand letters? If there are taking money back without letting you know you should get your hospital lawyers on that?
 
Ours weren't recent dates of service either, I think 2007. Yes we got demand letters. I am on the committee but I am not that involved since they haven't started hitting the pro fee side yet, but I do know that they have been able to call our RAC and go over the documentation and get them to reverse their decision to take money back.

We aren't the only ones fighting the takeback too soon issue and believe me we are fighting it.

Laura, CPC, CPMA, CEMC
 
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