Health Information Management

Providers report first RAC denials in Florida, South Carolina

HIM-HIPAA Insider, November 17, 2009

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Healthcare providers in several states received their first RAC denials. Connolly Healthcare, the Region C RAC for Florida, South Carolina, and several other states, has been behind many of them.
One hospital in South Carolina reports having three claims denied. However, learning of those denials did not go smoothly. The hospital received a call in late October from Connolly regarding a denial letter the hospital never received. The RAC sent the original denial letter in early August, and although it was addressed to the hospital, it apparently had no specific contact person listed, and the hospital never received it. The hospital had provided Connolly with the name of the contact person for their facility months prior via the form Connolly provided on its Web site, according to a hospital employee.
“Connolly acknowledged that the absence of a contact person on the letter was their error and they are working to correct it,” she said.
In the meantime, the RAC faxed a copy of the denial letter to the hospital. The total take back was less than $200, but it has given the hospital a chance to test its RAC tracking system, which is reportedly working well thus far.
Another small contract rehab company that contracts with facilities across seven states, mainly in the southeast, also reported receiving RAC denials. Three of its facilities, all skilled nursing facilities averaging 120 beds, have now received demand letters, according to the Florida-based provider.
“A majority of what we are seeing is recoupment of service-based codes billed in error more than once per day, mainly speech therapy (ST) service-based codes,” according to a provider employee. “We have also received two that included recoupment for the ST codes of 92610 and 92526 billed on the same day, which we have disputed and reported this issue to the American Speech-Language-Hearing Association.”
The provider is appealing the denials where the RAC is seeking recoupment of the ST codes 92610 and 92526 billed on the same day.
“We have a dedicated denials and appeals department and we have been handling these very efficiently and effectively,” she said. The provider has had no problems so far with the appeals it has submitted.
The provider also noticed that the demand letters seem to be taking approximately two weeks to arrive, so timing is of the essence, particularly if the provider is going to respond with appeals.

The provider also notes that it has used the denials as a guide for its internal auditing. Staff members are now going back to look for trends or patterns related to those denials.

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