Up until now, Recovery Audit Contractors (RACs) have only been approved to issue demand letters for multiple, untimed codes:
- evaluation (97001)
- re-eval (97002)
- e-stim (G0283)
- traction (97012)
- etc
The RACs would review your billing profile using computerized, 'data drilling robots' that spot these un-listed Common Procedural Terminology (CPT) code edits and send you a demand letter.
The demand letter would arrive, automatically generated, with days, patients and dollar amounts listed.
Since multiple untimed codes are 'technical denials' there is no appeal.
Now, RACs are approved for complex review - that means they can request and review copies of your charts. They will attempt to find issues that would give basis for a medical necessity denial.
You can appeal medical necessity denials - and you should.
There is evidence that RACs inappropriately interpret published Medicare guidelines in making their denials.
For my state, Florida, Connolly Healthcare is the CMS-approved RAC. Connolly also administers the RAC program for Alabama, Colorado, Florida, Georgia, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, and Texas.
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