Recovery Audit Contractor ("RAC") and Medicare Coverage Appeals

PPSV has assembled an experienced team of attorneys specializing in the Medicare administrative appeals process, including issues related to RAC audits, Program Safeguard Contractor (“PSC”) reviews, and extrapolations.  PPSV has successfully assisted providers in thousands of coverage appeals resulting from payment denials by RACs, PSCs, and fiscal intermediaries.  The team works with all provider types, particularly inpatient rehabilitation hospitals and units, acute care hospitals, specialty hospitals, physicians and other providers.  Services are tailored to the particular needs of each provider and can include any of the following:

• Proactive compliance measures to limit exposure and prepare for auditing activities;
• Customized strategies and legal analysis of issues arising during the appeals process;
• Guidance in establishing mechanisms for handling significant numbers of audits and claims denials;
• Creation of appeal “templates” and model letters for provider use;
• Review of appeal documents prepared for submission;
• Hands-on preparation of appeals documents; and
• Direct representation at ALJ hearings and participation in appeal preparation sessions with clinical staff.

PPSV serves as counsel to the Fund for Access to Inpatient Rehabilitation (“FAIR Fund”) and Palomar Medical Center in a federal court challenge to procedures used by RACs.  For additional information, see the FAIR  Fund’s press release.  [press release]

In addition to the other attorneys involved, the team is headed by Peter W. Thomas and Ronald S. Connelly.  Please contact either Peter or Ron for further information about the services provided by the firm’s RAC Audit & Medicare Appeals Team.