CMS Final Rule Upholds Regulations on RAC Appeals

CMS has basically upheld its previously stated rules on how hospitals and other providers can prevent recoupment of Medicare disputed payments during appeals of decisions by recovery audit contractors, according to a final rule published in the Federal Register.

The final rule states that hospitals and other providers can prevent RACs’ recoupment during the appeal if they file the first level of appeal within 41 days after an adverse decision; then they have 60 days to file the second level of appeal in order to prevent recoupment during that appeal.

The final rule also states that if an overpayment determination is overturned in the third level of appeal, before an administrative law judge, CMS is liable for interest on any recouped overpayments, accrued since the original determination.

The final rule is effective Nov. 16.

Read CMS’ final rule on RAC decisions appeals (pdf).

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