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Medical Coding News Archives

RAC Recoupment Causes Confusion

 
May 13, 2010:

Providers are noting a number of issues with this process, including the use of incorrect remittance advice remark codes and recovering amounts that differ from those requested in the overpayment demand letter.

Officials with the Centers for Medicare and Medicaid Services acknowledge some problems and are working with the RACs to remedy any and all issues. They have asked for patience with this matter due to the implementation of a new system that still has a few remaining glitches to be mitigated. Additionally, CMS is asking providers to ask their RAC to clarify or correct any errors associated with a recoupment.

When a claim is adjusted due to a RAC overpayment, the remittance advice should indicate remittance advice remark code (RARC) N432 (Adjustment based on a recovery audit). CMS created this code to identify RAC-adjusted claims; however, the agency states that N432 is at times being superseded by RARC N469 Alert: Claim/service(s) subject to appeal process, see section 935 of Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), which is section 935 Limitation on Recoupment code. CMS is actively working to correct this problem in the system.

In the meantime, providers should carefully match demand letters to any offsets that appear on the RAs. All demand letters include an internal control number (ICN) or document control number (DCN). The ICN or DCN is also indicated on the RA so that it may be linked back to the demand letter. If it is necessary to communicate to the RAC, be sure to include the ICN or DCN.

Deborah C. Hall Clinical/Technical Editor

Key Terms: Recovery Audit Contractors, RAC, overpayments, recoupment, remittance advice

 

 
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