JACKSONVILLE, Fla. – C2C Innovative Solutions, the contractor handling the second level of the Medicare appeals process, has received the green light from CMS to expand a demonstration project that allows HME providers to speak with reconsideration professionals by phone to try and resolve their cases.
CMS has selected five new recovery audit contractors (RACs) and established new rules. RAC audits will undoubtedly resume soon. Performant and Cotiviti were awarded contracts, along with HMS Federal Solutions.
As if the sheer quantity of audits wasn’t enough to contend with, HME providers often have to untangle inconsistencies in regulations and guidance, says Stephanie Morgan Greene, a healthcare attorney who’s executive vice president of business development for AC
A. To reduce or remove the extrapolation, you will need to appeal the overpayment determination, addressing both the individual claims reviewed in the audit and the extrapolation itself. Consider this a two-tier appeal process.
WASHINGTON – Twelve percent of HME claims for new patients, on average, were subject to MAC prepayment audits in the fourth quarter of 2015, according to data collected through AAHomecare’s HME Audit Key.