RAC AUDIT ALERT: Respiratory Assist Devices

On December 17, 2017, Performant Recovery, the National DMEPOS RAC, added Respiratory Assist Devices (RADs) to their approved issues list. According to their website, Performant Recovery will perform complex reviews of these claims to determine if coverage criteria and/or medical necessity requirements were met.

Codes included in the audit are: E0470, E0471

Performant will review coverage criteria outlined in the LCDs and Policy Articles. It is important to note that the RAC can review claims having a “claim paid date” as far as 3 years back. Be mindful of both current and retired LCDs based on the date of service being audited.

For more information on the coverage criteria being reviewed, please refer to our previous post regarding proposed RAC issues.

Want some help? Come to the experts! 

The van Halem Group offers proactive and reactive services to assist you. If you receive an audit request from the RAC our clinical team will review the claim file and respond to the audit on your behalf. If denied, we will work with you to obtain addendums and appeal the overpayment.

Even more beneficial to you, is to allow our team to work for you proactively. Our clinical prescreen program provides reassurance that your documentation meets coverage criteria before you bill the claim. Our clinical team will review your claim prior to billing and work with you to obtain essential documentation from the ordering physician. Prescreens are charged on a per file fee.

Contact us for more information!