How it Works

Urgent RAC Support

Highlighted below is an overview of the three possible scenarios you’ll likely face when your RAC communicates with you.

Scenario 1

Demand Letter

An overpayment demand letter is received without any corresponding request for medical records.

Scenario 2

Record Request

Request for one or more medical records is received.

Scenario 3

Record Response

An overpayment demand letter arrives after you respond to a record request.

Protocol

What to Expect

RAC requests will arrive as a letter usually addressed to the physicians, the practice administrator or whomever you designated to act as the “contact person” on your CMS-855 enrollment form.

The RAC letter will always have a CMS logo somewhere on it. The better also often contains the letterhead of your RAC and your carrier, because RAC’s communicate all determinations to your carrier, which then adjusts reimbursement and records the adjustment via remittance advice. You’ll know it’s a RAC letter because it should be coming from your regional RAC.

Your RAC Letter Should Contain The Following

Your Rights

Your rights of appeal.

Procedures

Payment refund procedures.

Audit Results

Audit results, indicating whether you owe an overpayment or Medicare owes you for an underpayment.

Contact

Contact information for the RAC.

Specific Violation

The specific coverage, coding, or other payment policy (or policies) violated.