The Step-By-Step Guide to Your RAC Audit

Hanger is dedicated to helping you navigate the RAC audit process. The less time you spend dealing with paperwork, the more time you can spend taking care of the patients who need you.

Before you begin, review your audit correspondence to determine if you're dealing with a Complex RAC Review or an Automated RAC Review.

Then follow the step-by-step guide below to walk you through the process.

Choose Complex or Automated RAC Review
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Downloadable Documents and Forms

Appeal Documents

The below documents can be used to appeal specific types of Medicare denials.

For Denial Language That… Use… Because…
References the terms “Medical Necessity,” “Not Reasonable” or “Necessary” LE Pros Medical Necessity Verification All standards of medical necessity are compliant with Medicare policy language and Local Coverage Determination (LCD).
References “Lack of Medical Notes” or “Lack of Medical Documentation” Medical Documentation Verification Medical Records are compliant and document the services provided as per Medicare policy language and Local Coverage Determination (LCD).
Is based upon reasoning related to Medical Necessity. Orthotic Medical Necessity Verification All standards of medical necessity are compliant with Medicare policy language.
Inaccurately states that a suction socket cannot be billed with a pin suspension system. L5671 Application Medicare LCD and policy language clearly states a suction valve (L5647, L5652) can be used with the L5671.
Inaccurately states that no more than two liners can be provided. Liner Frequency Denial is based upon inaccurate interpretation of Medicare LCD. Policy allows for more than two liners with a restriction that states that no more than two of the same socket inserts (L5654-L5665, L5673, L5679, L5681, L5683) are allowed per individual prosthesis at the same time. Patient did not receive more than two of any one liner.

Appeal Forms

The below documents will help you complete your appeals forms accurately. Use the links provided to access the official forms directly on the Medicare website.

Sample Forms Links to Official Forms
Medicare Redetermination Form Step By Step http://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/downloads/cms20027.pdf
Medicare Reconsideration Form Step By Step http://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/downloads/cms20033.pdf
Request for ALJ Step By Step http://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/downloads/cms20034ab.pdf
ALJ Confirmation Step By Step http://www.hhs.gov/forms/HHS729.pdf
ALJ Appeal Step By Step http://www.cms.gov/Medicare/Appeals-and-Grievances/OrgMedFFSAppeals/Downloads/DABform.pdf

Additional Resources

Best Practices and Advice

Hanger has compiled some information to help you through the RAC audit process.

Best Practices and Advice

Checklists

The below documents offer a simple checklist of the step-by-step processes for Automated and Complex RAC Reviews

Automated Chronology Checklist
Complex Chronology Checklist

Why Is Hanger Helping?

Healthcare practitioners always have good work to do. But too often, they spend a lot of time dealing with healthcare challenges like the RAC Audits.

By providing the tools and resources to navigate the RAC process, we hope to help streamline a challenging part of the business. A streamlined business is a more efficient business, and when the industry improves across the board, everyone benefits, especially patients.

If you have any questions about the process, please email us at RAC@hanger.com.