RAC is Recovery Audit Contractors which deals with Prepay and Postpay audit appeals and they are responsible for identifying improper medicare payments and implement action accordingly to reduce these improper payments.
Mashcom helps in handling Prepay and Postpay appeals. We have experienced certified physicians, healthcare executives who can guide you through the appealing process regarding overpayment denials. Since written appeal request is required, our physicians write an appeal letter on your behalf considering the medical records and by following industry standard guidelines such that you get winning Prepay and Postpay appeal.
MAC is Medicare Administrative Contractors which deal mainly with Prepay audit appeals. They also have few Postpay accounts too.
Yes, in case you bill for the fee-for-service program then all your claims will be reviewed by RAC's
You can stop recoupment process, if you are submitting an appeal within the deadline that is specified. For Level 1 cases, you have to submit your redetermination appeal within 30 days from the date of first request letter to stop recoupment. In case the decision at this level is unfavorable then you can appeal to level 2(QIC) within 60 days from the date of redetermination decision.
Mashcom follows two main industry standard guidelines like Milliman and InterQual. Inpatient admission is justified using these two guidelines.
Providers can take advantage of the limitation on recoupment provision by not repaying the overpayment during the first and second levels of the appeals process. The pitfall, however, is that interest will still continue to accrue during that entire time. If a physician loses at either of the first two levels and they elected not to repay their overpayment determination during the appeal, then they will owe medicare both the principal overpayment determination amount and accrued interest.
All your RAC letters are written by experienced certified physicians who are completely aware of the medical literature that RAC follows and understand the importance of industry standard guidelines.
Mashcom prominently deals with MAC (Medicare administrative contractors), Level1 (demand), Level 2(QIC- Qualified intermediate contractors) and Level 3(Administrative Law Judge).