Medicare RAC Appeals: Tips from Healthcare Management Consultants AMS

Burlington, MA – Health care management consulting firm Applied Management Systems, Inc. reports a success rate exceeding 97 percent spanning hundreds of claim reviews and appeals of Medicare audits on behalf of health care clients nationwide. According to Linda Young, JD, RHIA, assistant general counsel and senior consultant at AMS, Medicare’s Recovery Audit Contractor Program (RAC), appeals "can be very involved, time-consuming and complicated, but the rate of reversal suggests it is worth the effort yet only a fraction of hospitals have the internal resources to appeal.

Young advises positioning the health care facility to:

• manage results efficiently at an early stage
• evaluate each case thoroughly
• avoid technical denials at all costs
• preserve the right of appeal
• engage the proper resources to help recover funds.

“Once Medicaid reviews are in full swing, a well organized appeal management process will be even more vital,” Young said. She recommends that health care providers undergoing overpayment review “engage experienced health care lawyers and consultants to support their appeal efforts throughout the administrative law judge level in order to receive all the money to which they are entitled.”

Since 2008, Young has assisted health care clients nationwide in managing the array of audit cycles and deadlines required to preserve their right to appeal. Additionally, she works with AMS clients to formulate a powerful foundation which can be used throughout the multiple step of any appeal process.

“Health care providers rarely prevail in the first or second round, but the provider should stay on course through the third level where the administrative law judges are insulated from the pressures of CMS,” Young said.

For more information on RAC appeals, or to read the full press release on this topic, contact AMS.