RAC Demand Letters

MACs to Begin Sending RAC Demand Letters Starting January 3, 2012

As of January 3, 2012, The Centers for Medicare & Medicaid Services (CMS) is transferring the responsibility for issuing demand letters to providers from its Recovery Audit Contactors (RACs) to its Medicare Administrative Contractors (MACs).

CMS Change Request CR-7436, effective January, 2012, orders the MACs to send demand letters for RAC adjusted claims. Demand letters will no longer be a RAC responsibility as of January 3 2012 

MACs will:

• Establish the Accounts Receivable (AR) and send demand letters following the normal improper payment process (similar to MAC 935 process)
• Answer provider’s administrative concerns regarding recovery timeframes and appeals
• Include RAC contact information on the demand letters

Connolly will:

• Continue producing Review Results letters for complex reviews
• Answer provider questions / concerns regarding audit specific questions
• Produce review rationale content for automated and semi-automated reviews. Review Rationale content will be available to providers / suppliers via Connolly’s Provider Portal on or before January 3, 2012.
• Content will include ICN, DCN, and adjustment amount(s).  No Personal Health Information will be displayed on the provider portal. The provider will only be able to view its specific RAC claims.

For more information regarding the demand letter change, please follow the web-links:

https://www.cms.gov/transmittals/downloads/R192FM.pdf
https://www.cms.gov/Recovery-Audit-Program/Downloads/MLNMattersArticle.pdf