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MACs Now Responsible for Issuing Medicare Audit Overpayment Demand Letters

On July 29, 2011, the Centers for Medicare and Medicaid Services (CMS) issued Change Request 7436 which shifts the duty of issuing demand letters for identified overpayments from the Recovery Audit Contractors (RACs) to the Medicare Administrative Contractors (MACs). RACs will continue to be responsible for determining whether an improper payment has been made to a provider. However, after identifying an overpayment, RACs will now submit the claim to the MACs who will then send the demand letters to the identified providers. All communications regarding payment recovery and appeal process timeframes will be handled by the MACs, but a provider’s questions or concerns relating to audit specificities should be directed towards the RACs.

Providers need to be aware of this recent change in order to prevent any miscommunications that could lead to missing an appeal deadline. A small error such as this could lead to forfeiting any appeal rights that a provider is granted. If you have any questions relating to RAC audits, or any other type of Medicare or Medicaid audit, please contact a Wachler & Associates attorney at 248-544-0888.