Mashcom Enterprise LLC is the best resource for Prepay and Postpay audit appeals. Mashcom works in collaboration with certified physicians, healthcare executives and billing compliance advisors to provide winning appeals. Mashcom provides RAC (Prepay and Postpay Audits) and MAC (Prepay Audit) appeals service to every healthcare service provider. These appeals normally include overpayment denials.
Overpayment Denials can be due to improper medical necessity, incorrect coding service or incorrect payment amounts. RAC should use proper medical literature and need to apply on the clinical judgement for individual claims. If the RAC identifies overpayment, then it provides written notification requesting for the reimbursement of overpayment.
If you have received a letter from the Recovery Audit Contractor (RAC) requesting for overpayment and think that it is inappropriate then you can file an appeal. As a beneficiary you have the complete right to appeal the determination as well you can transfer your appeal rights to physicians or service providers who provided you the service. The appeal requests can be made by physician. The physician should file an appeal within 30 days of receipt of overpayment letter in order to avoid recoupment.
We follow the industry based standard guidelines like Milliman and InterQual to write an appeal. Our main motive is to ensure that our clients receive proper payment for the services rendered to beneficiaries. As we understand the importance of deadlines in appealing your claim, we employ your appeal within the specified deadline. We focus on three main levels in appeals process which include Fiscal intermediary contractors (Demand) or Medicare Administrative Contractor (MAC), Reconsideration by a Qualified Independent Contractor (QIC) and Hearings before an Administrative Law Judge (ALJ).