Revenue Cycle

From the field: The demand letter problem grows

Recovery Auditor Report, January 26, 2012

A RAC coordinator at a hospital in Region B (who wished to remain anonymous) shared one of her latest recovery auditor stories with the Revenue Cycle Institute. She explained that her facility was assigned a new MAC, CIGNA Government Services, and that her facility has a back log of 125 claims from CGI. In addition to this, the demand letter responsibility has shifted to the MAC, so she isn’t sure what to expect, concerning timeliness and correspondence.

“We were informed that CIGNA will send the letter to the address that is in their file, which is not the address where the demands from Region B RAC were sending the letters to,” she says.  “In addition, we received a template yesterday -- I believe CMS released it -- but no envelope was attached so we don’t know what we’re looking for.”

 She continued, “It would be nice for the first two months of the switch that the deadlines either be waived or extended.  We had been receiving the demand letters usually 7 to 10 days from the date on the letter, so it will be interesting to see how this evolves.”

Do you have any advice, comments, or questions for this provider? Has something similar happened at your facility? Have you contacted/heard back from your particular recovery auditor or MAC?

These “Share your RAC story” submissions are intended to show other provides out there that these things are happening everywhere. But they are also intended to create conversation and connect likeminded individuals. Have you been experiencing any type of problems with recovery auditors lately at your facility? Would you like to offer advice to this reader by sharing your experience? If you do, or if you have ideas, questions, or concerns of your own, then submit them to jcarroll@hcpro.com.

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