RAC Appeals Support Overview

Develop and Implement a RAC Appeals Program

Many providers are appealing most cases with adverse RAC contractor findings. While this approach is understandable given the financial and public relations effect of the RAC program, many of these appeals will not be successful through all appeal levels. Given heavy workload and resource constraints, providers need to develop and implement a balanced RAC Appeals Policy and program that concentrates appeals efforts where they will garner the best results.

Benefits

• Determine which cases are appropriate for appeal
• Establish the appeal strategy
• Author the appeal response with professional support

Comprehensive Approach

The OptumInsight RAC Appeals Support Program consists of two separate but related processes that provide immediate support to help establish a long-term internal appeals process and includes:

1. Assistance in development and/or evaluation of the internal RAC processes
2. Assistance with or providing RAC appeals support

Expert Support

We help you review cases provided to the RAC and initial outcomes, determine which cases are appropriate for appeal, establish the appeal strategy, and help author the appeal response using coding technical support and external physician review and support.