tci Medicare Compliance & Reimbursement - 2010 Issue 5

RAC MANAGEMENT: RAC Appeals Target Misuse of Approved Reviews, Unfair Recoupment Amounts

Find out how rehab providers and a DME company are fighting back. Some providers aren't taking what they view as unfair RAC denials lying down.Case in point: In Florida, "providers have had Part B rehab therapy claims denied because claims had two untimed codes appearing on the same claim," says Nancy Beckley, MB, MBA, CHC, a consultant with Bloomingdale Consulting Group Inc. in Brandon, Fla.The problem: "There is no prohibition against billing two untimed codes -- the approved [RAC] issue is for two units of an untimed code," says Beckley. And, "Florida providers are appealing...

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