Health Information Management

Understand Medicare appeals process to ensure RAC success

Briefings on Coding Compliance Strategies, January 1, 2010

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Understand the timeline

Providers must respond to complex reviews (i.e., those for which RACs request actual medical records) within 45 days. Although RACs have said they will allow providers 45 days plus an additional 10 business days for mailing, Twist advises against relying on this extension. “I would pretend it doesn’t exist,” she says. Even if an appeal is en route but not yet keyed into the RAC’s system, the RAC will assume it’s delinquent, she cautions.

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