Recovery Audit Contractor (RAC) Appeals

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Hooper, Lundy & Bookman’s experience with RAC appeals is unparalleled.  To date our attorneys have handled more than 850 claims on behalf of our hospital clients.

Highly successful in the RAC arena, we have collectively saved our clients millions of dollars as a result of our representation.

Nationally recognized for our Medicare regulatory expertise, we have represented clients in Medicare administrative hearings for more than two decades. No one understands the RAC process, the Medicare Appeals process, or the key players with more depth than our attorneys. We have represented clients in numerous in-person hearings before the majority of the Administrative Law Judges at the Office of Medicare Hearings and Appeals for the Western Field Office. We are also called upon by prominent health care associations to provide consultation and analysis for their provider members.

Our attorneys are regularly engaged to handle these appeals because of their unique combination of Medicare regulatory expertise and clinical acumen. The firm’s seasoned regulatory and nurse attorneys integrate complex and innovative legal and regulatory challenges with traditional clinical aspects of RAC audit appeals to ensure that we have the strongest strategies available for our clients.

Based on our experience, we have found that hospitals can easily become overwhelmed with the sheer volume of information requests and numerous complex and varied deadlines imposed by RAC auditors and the Medicare appeals process. As a result, we have developed a personalized, hands-on approach that efficiently brings together the key resources needed within a hospital to ensure that critical deadlines are met and documents are submitted in a timely and efficient manner.

We assist our clients through every step of the process – from first notice of a request for records through handling of Administrative Law Judge hearings and subsequent appeals if necessary. Our specific RAC appeal services include:

  • Working with hospitals to set-up internal operational processes that:
    • Establish effective calendaring systems
    • Ensure documentation and other materials are submitted by deadlines
    • Create vital communication lines between business and clinical operations
    • Allow hospitals to handle Level 1 and Level 2 appeals internally
  • Creation of template letters for the Level 1 (Request for Redetermination) and Level 2 (Request for Reconsideration) appeals
  • Strategic development and execution of Level 3 Administrative Law Judge hearings, including
    • Filing of hearing requests and Response to Notices of Hearing
    • Review of the Administrative Case File at the Office of Medicare Hearings and Appeals
    • Filing of applicable briefs and pre-hearing documents
    • Interaction with the Office of Medicare Hearings and Appeals concerning appeal issues
    • Hearing preparation with witnesses
    • Representation at the Hearing
  • Handling of Level 4 (Medicare Appeals Council) and Level 5 (Federal District Court) appeals
  • Educating hospitals on compliance with regulatory requirements
For media inquiries, please contact Barrett McBride at bmcbride@health-law.com or 916.456.5855.