With all the audits we are receiving it has come to my attention that many of our members do not understand fully how they are to appeal a denial received from a RAC or other entity.
If you receive a denial from ANY outside group such as CERT/RAC /or ZPIC you must appeal …..
When the RAC (or any auditor) sends you a denial they will also notify you’re Jurisdiction (A – B –C or D) and this is when you proceed with your appeals. Once you have received a demand letter or EOMB with offset you will begin the appeals process. You must respond within 30 days to prevent further off sets or automatic recoupment’s.
Starting with a redetermination (making sure you send in the redetermination form from your Jurisdiction) and plainly state this if for a RAC (or CERT or ZPIC) recoupment request.
1. Make sure you identify the auditor
2. Send in a copy of the letter received from them.
3. Make sure you follow the appeals procedures
4. Use the check off sheets you can find on your local carrier sites or on the US Rehab.com site
5. Send everything that relates to the need for the item the first time.
6. Check signatures and dates
For more information contact: Peggy Walker or Ronda Buhrmester at
Peggy – firstname.lastname@example.org 800-401-3643
Ronda – email@example.com 888-665-6518