The United States Department of Medicare and Medicaid Services (CMS) uses a number of different resources to aid in the completion of its many operations. This includes contracts with different entities to help determine if the CMS made overpayments to health care providers.
These entities then have the authority to reach out to the health care organization that it suspects is the recipient of an overpayment and demand return of the funds.
Who are these resources?
One such entity are Recovery Audit Contractors (RAC). This group will conduct an audit and send your organization a letter if it determines that your organization received an overpayment. This letter generally takes one of two forms: a request for additional documentation or a demand for repayment.
The request for additional documentation is just that, the RAC asking for access to more medical records to complete its audit. The demand letter is sent upon completion of the audit if the RAC finds your organization received an overpayment. This letter will generally include a clear statement of the amount the RAC claims you received in error and request that your organization repay this amount. It will then explain how it believes the alleged overpayment occurred and provide contact information if you have questions about the process. It will also encourage those who disagree with the finding to reach out to the Recovery Auditor.
What happens if I do not respond?
The RAC will begin to add interest to the amount due and may begin recoupment measures by withholding payment from future claims.
What are my options?
If you believe the finding is correct, you can explore repayment options. However, it is important to note that you do not have to agree to the RAC’s findings. You can challenge the finding through a rebuttal or appeal.