RAC counter audit
fairman11
Description
Collection
Title:
RAC counter audit
Creator:
fairman11
Date:
5/9/2013
Text:
List,
Do we have any recourse when an RAC is so painfully wrong and unjustified
or are we just happy to get our payment eventually?
The situation is very easy in this case.
1. We had the per usually audit which is now 100% assured in every
prosthetic case.
2. We have all of our documents, notes, signatures etc prepared ahead of
time so that we can turn our documentation over asap after we get the
rejection.
3. In this case we were rejected and after calling the provider help line
to determine why, because our files were so complete, we were perplexed.
4. The help line told us No Delivery Slip. The delivery slip was very
clearly included in the first set of documentation submitted. It was
listed on the cover sheet we include as #6 Delivery acknowledgement with
signature. It is dated correctly, it is signed, all L-codes are clearly
present on the slip, etc. etc.
If a delivery signature page is clearly labeled delivery acknowledgement
and is completely ignored and rejected, who may I confront?
We certainly plan to ask for interest, log a complaint, etc. But, I wonder
has anyone been able to speak to an auditor who is actually reading the
file? Who is help accountable for such an obvious error?
This rejection was also labeled not medically necessary as opposed to
documentation missing. Is there a way I can call simply and say look
again, the delivery receipt is there? When a rejection is labeled not
medically necessary, I'm more likely to go into letter writing mode and
spend hours justifying each and every L-code, in this case a waste of time.
Any suggestions are appreciated.
Chris Fairman, CPO
Great Lakes P&O
Ypsilanti, MI
734-528-5200
Do we have any recourse when an RAC is so painfully wrong and unjustified
or are we just happy to get our payment eventually?
The situation is very easy in this case.
1. We had the per usually audit which is now 100% assured in every
prosthetic case.
2. We have all of our documents, notes, signatures etc prepared ahead of
time so that we can turn our documentation over asap after we get the
rejection.
3. In this case we were rejected and after calling the provider help line
to determine why, because our files were so complete, we were perplexed.
4. The help line told us No Delivery Slip. The delivery slip was very
clearly included in the first set of documentation submitted. It was
listed on the cover sheet we include as #6 Delivery acknowledgement with
signature. It is dated correctly, it is signed, all L-codes are clearly
present on the slip, etc. etc.
If a delivery signature page is clearly labeled delivery acknowledgement
and is completely ignored and rejected, who may I confront?
We certainly plan to ask for interest, log a complaint, etc. But, I wonder
has anyone been able to speak to an auditor who is actually reading the
file? Who is help accountable for such an obvious error?
This rejection was also labeled not medically necessary as opposed to
documentation missing. Is there a way I can call simply and say look
again, the delivery receipt is there? When a rejection is labeled not
medically necessary, I'm more likely to go into letter writing mode and
spend hours justifying each and every L-code, in this case a waste of time.
Any suggestions are appreciated.
Chris Fairman, CPO
Great Lakes P&O
Ypsilanti, MI
734-528-5200
Citation
fairman11, “RAC counter audit,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 25, 2024, https://library.drfop.org/items/show/235178.
