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Consideration radiology providers and suppliers: Prepare for increased Medicare auditing activity. The Centers for Medicare and Medicaid Companies (CMS) Restoration Audit Contractor (RAC) program has been made permanent and is expanding nationwide, starting this year. Claim denials and overpayment determinations made by RACs are subject to the Medicare appeals process. Radiology providers and suppliers are well advised to grasp the Medicare appeals course of and will acknowledge that there are numerous efficient strategies that can be efficiently employed within the appeals course of to defend Medicare audits.
Additionally, the provider without fault defense could also be employed in the case of publish-payment evaluate denials. The Medicare provider with out fault provisions, Part 1870 of the Social Safety Act, states that fee can be made to a supplier if the supplier was with out fault” with regard to billing for and accepting fee for disputed services.
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