The RAC Taketh Away…and Giveth?

Posted on in Billing/Reimbursement, HME Government Issues

By Dan Fedor, U.S. Rehab Reimbursement Specialist

 Dan Fedor

The RAC is well known for audits and recovery of overpayments (they taketh away). But, does the RAC ever giveth? As far back as I can remember, I've never heard of any Medicare contractor reviewing claims for UNDERPAYMENTS then giving money, which is due, back to the providers. You may not be aware of this, but the RAC is funded to find underpayments. And, on May 17, 2017, Performant Recovery, the National DMEPOS RAC, announced that it will begin to recover underpayments or incorrect reductions owed to suppliers for wheelchair accessories and cushions for Group 3 complex power rehab wheelchairs. This underpayment review was suggested by the van Halem Group’s Wayne van Halem!

What This Means to You

The RAC has been given approval from CMS to begin reviewing underpayment for accessories used on Group 3 power wheelchair bases for dates of service Jan. 1, 2016 - June 30, 2016. This timeframe is when the DME MACs' processing system was not able to accept the KU modifier, which would allow the claims to pay at the unadjusted fee schedule (the one NOT affected by competitive bid pricing). Providers were able to submit a written reopening for these underpayments after July 5, 2016, once the DME MACs' processing system was updated to accept the KU modifier and pay at the unadjusted fee schedule. U.S. Rehab issued many articles/webinars on this situation with details of how to recover these funds via written reopening; however, some providers have not submitted the reopening to request the additional money owed to them.

 Wayne van Halem

Fortunately, thanks to Wayne van Halem’s suggestion, the RAC has announced that for Group 3 power wheelchair claims with these dates of service that have not yet been adjusted at the providers request, they will reprocess and issue additional reimbursement. The average amount of these adjustments for a Group 3 multiple power base (K0861) is approximately $1,000 per claim. See the attached list of affected accessories.

Read the original announcement from The van Halem Group.

If you have any question regarding this information, please contact me:

Dan Fedor
Reimbursement Specialist, U.S. Rehab
VGM Group, Inc.
Proud Employee Owner
O: 844-794-8459
C: 570-499-8459
E: [email protected]
F: 844-307-5729