CMS Highlights Differences in RAC Appeal Process and Regular Medicare Appeal Process

The following Q&A comes from the Centers for Medicare & Medicaid Services website.

Q: Will the Recovery Audit Contractors appeal process mirror the regular Medicare appeal process?

A: The Medicare Appeals process will remain the same for physicians under Part B and Part A non-inpatient claims. The only difference under Part A is for the inpatient hospital claims under the Prospective Payment System (PPS). In the current appeals process, the first level appeal will go to the Quality Improvement Organization (QIO); however, the RAC appeals will go to the Fiscal Intermediary that processed the claim.

Source: CMS

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