Providers Report First RAC Denials in Florida, South Carolina

Another small contract rehab company that contracts with facilities across seven states, mainly in the southeast, also reported seeing RAC denials. Three of its facilities, all skilled nursing facilities, averaging 120 beds, have now received demand letters, according to the Florida-based provider.

"A majority of what we are seeing is recoupment of service-based codes billed in error more than once per day, mainly speech therapy (ST) service-based codes," according to the provider. "We have also received two that included recoupment for the ST codes of 92610 and 92526 billed on the same day, which we have disputed and reported this issue to the American Speech-Language-Hearing Association."

The provider is appealing the denials where the RAC is seeking recoupment of the ST codes 92610 and 92526 billed on the same day.

"We have a dedicated denials and appeals department and we have been handling these very efficiently and effectively," the provider said. The provider has had no problems so far with the appeals they have submitted.

The provider also noticed that the demand letters seem to be taking approximately two weeks to arrive, so timing is of the essence, particularly if the provider is going to respond with appeals.

The provider adds that it has used the denials as a guide for its internal auditing. Staff members are now going back to look for trends or patterns related to those denials.