Recovery Audit Contractor News

The Recovery Audit Contractors have arrived! Several of our clients report receiving letters from the RACs requesting refunds for a variety of issues. The primary ophthalmic issues seem to be the following:

  • Place of service errors
  • New patient visits
  • Global surgery issues including modifiers 24, 25, and 78
  • NCCI edits

If you receive a demand letter from your RAC, pay particular attention to the timeframes for appeal. Even though the letter implies that you made an error, if you review the chart and feel confident in your documentation, you should appeal. We have seen many successful appeals.

In addition, at least one RAC, Connolly Consulting Associates, was inappropriately reviewing ambulatory surgery center (ASC) claims and sending out overpayment letters to ASCs. ASCs are not within the RAC scope of work. Further, the reason for the supposed overpayment was bogus.

It has also been reported that the overpayment requests associated with the national correct coding initiative (NCCI) edits may not be valid requests. The RAC is applying NCCI edits that were not in place at the time of service.

This program will continue to ramp up. It is extremely important that you respond promptly to their requests, file appeals as appropriate, and pay attention to the details of the overpayment request for accuracy or lack of it.

For additional information on RACs, request Corcoran Consulting Group’s FAQ on the RAC program.

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