In response to suggestions by the American Hospital Association and state and regional hospital associations, the Centers for Medicare & Medicare Services has revised the letter used to demand the return of alleged overpayments from health care providers under the Medicare Recovery Audit Contractor program. Beginning in January, Medicare administrative contractors will assume responsibility for sending the letters under a CMS policy change announced earlier this year to address timeliness concerns raised by hospitals.
A sample of the new letter, with the changes highlighted, can be found at www.aha.org. According to CMS, the "R" before the letter number is intended to help providers identify the letter as a RAC-initiated claim and redirect it to the appropriate staff.
AHA had urged CMS to require MACs to send the letters to a RAC contact address provided by the hospital, but CMS indicated it was unable to accommodate such an address in its computer system. Thus, hospital departments that receive MAC correspondence must distribute the RAC demand letters to the appropriate staff.
They also should speak with their MAC about ways to improve the process, and learn whether their RAC's provider portal indicates when a demand letter has been sent. Questions about the new letter and policy should be directed to the CMS RAC Project Officers.
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