From the field: Recoupment before receipt of demand letters
Recovery Auditor Report, December 2, 2010
The Revenue Cycle Institute recently had a brief conversation with Karen Sagen, managed care leader at Bellin Health Systems in Green Bay, WI, on a recent problem that has been confounding a number of providers nationwide.
Question: There has been talk out there about a confusion issue involving RACs. Apparently some providers have been seeing recoupment before the receipt of demand letters. Can you comment on this?
Answer: We have seen a lot of this and it’s definitely causing some confusion. What is actually happening is that the Medicare Explanation of Benefits (EOMB) shows the N432 code (a RAC denial code that appears on the remittance advice, which is a notice of payments and adjustments sent to providers, billers and suppliers.) and if you look at that entry, it looks as though money has been recouped. However, what is actually happening is that the N432 is attached to the claim at the time the demand letter is produced, which in turn activates the N432 on the EOMB.
Related Products
-
Core Skills for Hospital Case Managers:
A guide to fundamental case management responsibilities, Core Skills for Hospital Case Managers serves as a training...
-
Combat RAC Denials: Strategies for Successful Appeals
During this 90-minute audio conference, our speakers provide step-by-step procedures, timelines, tools, and best practices...
-
The 2013 Medicare Compliance Forum: Las Vegas, NV
-
Level of Care Determinations for 2014: Las Vegas, NV
Attend the half-day seminar, Outpatient, Observation or Inpatient? Continuing to Walk the Tightrope of Regulatory Guidance...
-
OPPS and IPPS Reimbursement Fundamentals: Las Vegas, NV
Attend OPPS and IPPS Reimbursement Fundamentals, a half-day seminar on October 2nd in Las Vegas. Learn how CMS’ substantial...
Most Popular
- Articles
-
- Don't forget the three checks in medication administration
- Nursing responsibilities for managing pain
- Steps for maintaining patient privacy
- Note similarities and differences between HCPCS, CPT® codes
- Practice the six rights of medication administration
- Q&A: Primary, principal, and secondary diagnoses
- Poor documentation: The consequences
- Know guidelines and subtle differences in code descriptions for laceration repairs
- The consequences of an incomplete medical record
- Neurological checks for head injuries
- E-mailed
- Searched