What are the different types of letters that my facility will receive related to improper payments?

The letters the RACs will send vary by whether it has identified an improper payment by automated or complex review. For automated reviews, providers will receive an informational letter beginning 1/3/12. For complex reviews, providers will receive a medical record request letter and a review results letter. In the event that the review results letter contains a notification of improper payment, a demand letter will then be issued.

What do I do when I receive a demand letter?

You first review the demand letter and Medicare regulation to understand the improper payment determination. To avoid any interest assessment, you should refund the monies within 30 days from the date of the demand letter; you have the option of issuing a check or requesting immediate offset by the Medicare Claims Processing Contractor. You may also have the amount recouped by taking no action after the receipt of the demand letter. If you choose recoupment, interest will be assessed after the 30th day. If you have additional information or disagree with the demand letter there are options available to you. You may file a Discussion (with the RA) by following the directions on your demand letter; or, you may file an appeal (with the Medicare Claims Processing Contractor), which if done within 30 days, stops recoupment. We strongly urge providers to submit any documentation or information relating to a Discussion with the RAC as soon as possible.

Providers have received notification that the Medicare Administrative Contractors (MACs) will begin issuing the demand letter on the Recovery Auditor (RA) improper payment findings. Will the MAC be sending out the demand letter on both the automated and complex RA reviews?

Yes. The MAC will be issuing the demand letters for all types of RA reviews

Providers have received notification that the Medicare Administrative Contractors (MACs) will begin issuing the demand letter on the Recovery Auditor (RA) improper payment findings. Who will issue the Underpayment Notification Letter?

The RAs will continue to issue the Underpayment Notification Letters.

Providers have received notification that the Medicare Administrative Contractors (MACs) will begin issuing the demand letter on the Recovery Auditor (RA) improper payment findings. Will I receive any notification of an improper finding from the RA?

Yes. The RA will continue to send Review Results letters on complex reviews and Informational Letters on automated and semi-automated reviews. The Informational Letters will supply the majority of the audit detail previously supplied with the demand letter on automated and semi-automated reviews. The Review Results and Informational Letter will be sent to the designated address listed on the HDI Provider Portal.

Providers have received notification that the Medicare Administrative Contractors (MACs) will begin issuing the demand letter on the Recovery Auditor (RA) improper payment findings. Who do I contact if I believe I should have received a demand letter but have not received it yet (after 1/3/2012)?

You would contact the Customer Service area at your MAC.

Providers have received notification that the Medicare Administrative Contractors (MACs) will begin issuing the demand letter on the Recovery Auditor (RA) improper payment findings. Who do I contact if I have a question or concern on a RA improper payment?

You would contact your RA. For Region D (HDI) you would contact the appropriate Provider Service number: Part A 866-590-5598 Part B 866-376-2319

What are the different types of letters that my facility will receive related to improper payments?

The letters the RACs will send vary by whether it has identified an improper payment by automated or complex review. For automated reviews, providers will receive an informational letter beginning 1/3/12. For complex reviews, providers will receive a medical record request letter and a review results letter. In the event that the review results letter contains a notification of improper payment, a demand letter will then be issued.

What do I do when I receive a demand letter?

You first review the demand letter and Medicare regulation to understand the improper payment determination. To avoid any interest assessment, you should refund the monies within 30 days from the date of the demand letter; you have the option of issuing a check or requesting immediate offset by the Medicare Claims Processing Contractor. You may also have the amount recouped by taking no action after the receipt of the demand letter. If you choose recoupment, interest will be assessed after the 30th day. If you have additional information or disagree with the demand letter there are options available to you. You may file a Discussion (with the RA) by following the directions on your demand letter; or, you may file an appeal (with the Medicare Claims Processing Contractor), which if done within 30 days, stops recoupment. We strongly urge providers to submit any documentation or information relating to a Discussion with the RAC as soon as possible.

Providers have received notification that the Medicare Administrative Contractors (MACs) will begin issuing the demand letter on the Recovery Auditor (RA) improper payment findings. Will the MAC be sending out the demand letter on both the automated and complex RA reviews?

Yes. The MAC will be issuing the demand letters for all types of RA reviews

Providers have received notification that the Medicare Administrative Contractors (MACs) will begin issuing the demand letter on the Recovery Auditor (RA) improper payment findings. Who will issue the Underpayment Notification Letter?

The RAs will continue to issue the Underpayment Notification Letters.

Providers have received notification that the Medicare Administrative Contractors (MACs) will begin issuing the demand letter on the Recovery Auditor (RA) improper payment findings. Will I receive any notification of an improper finding from the RA?

Yes. The RA will continue to send Review Results letters on complex reviews and Informational Letters on automated and semi-automated reviews. The Informational Letters will supply the majority of the audit detail previously supplied with the demand letter on automated and semi-automated reviews. The Review Results and Informational Letter will be sent to the designated address listed on the HDI Provider Portal.

Providers have received notification that the Medicare Administrative Contractors (MACs) will begin issuing the demand letter on the Recovery Auditor (RA) improper payment findings. Who do I contact if I believe I should have received a demand letter but have not received it yet (after 1/3/2012)?

You would contact the Customer Service area at your MAC.

Providers have received notification that the Medicare Administrative Contractors (MACs) will begin issuing the demand letter on the Recovery Auditor (RA) improper payment findings. Who do I contact if I have a question or concern on a RA improper payment?

You would contact your RA. For Region D (HDI) you would contact the appropriate Provider Service number: Part A 866-590-5598 Part B 866-376-2319

What are the different types of letters that my facility will receive related to improper payments?

The letters the RACs will send vary by whether it has identified an improper payment by automated or complex review. For automated reviews, providers will receive an informational letter beginning 1/3/12. For complex reviews, providers will receive a medical record request letter and a review results letter. In the event that the review results letter contains a notification of improper payment, a demand letter will then be issued.

What do I do when I receive a demand letter?

You first review the demand letter and Medicare regulation to understand the improper payment determination. To avoid any interest assessment, you should refund the monies within 30 days from the date of the demand letter; you have the option of issuing a check or requesting immediate offset by the Medicare Claims Processing Contractor. You may also have the amount recouped by taking no action after the receipt of the demand letter. If you choose recoupment, interest will be assessed after the 30th day. If you have additional information or disagree with the demand letter there are options available to you. You may file a Discussion (with the RA) by following the directions on your demand letter; or, you may file an appeal (with the Medicare Claims Processing Contractor), which if done within 30 days, stops recoupment. We strongly urge providers to submit any documentation or information relating to a Discussion with the RAC as soon as possible.

Providers have received notification that the Medicare Administrative Contractors (MACs) will begin issuing the demand letter on the Recovery Auditor (RA) improper payment findings. Will the MAC be sending out the demand letter on both the automated and complex RA reviews?

Yes. The MAC will be issuing the demand letters for all types of RA reviews

Providers have received notification that the Medicare Administrative Contractors (MACs) will begin issuing the demand letter on the Recovery Auditor (RA) improper payment findings. Who will issue the Underpayment Notification Letter?

The RAs will continue to issue the Underpayment Notification Letters.

Providers have received notification that the Medicare Administrative Contractors (MACs) will begin issuing the demand letter on the Recovery Auditor (RA) improper payment findings. Will I receive any notification of an improper finding from the RA?

Yes. The RA will continue to send Review Results letters on complex reviews and Informational Letters on automated and semi-automated reviews. The Informational Letters will supply the majority of the audit detail previously supplied with the demand letter on automated and semi-automated reviews. The Review Results and Informational Letter will be sent to the designated address listed on the HDI Provider Portal.

Providers have received notification that the Medicare Administrative Contractors (MACs) will begin issuing the demand letter on the Recovery Auditor (RA) improper payment findings. Who do I contact if I believe I should have received a demand letter but have not received it yet (after 1/3/2012)?

You would contact the Customer Service area at your MAC.

Providers have received notification that the Medicare Administrative Contractors (MACs) will begin issuing the demand letter on the Recovery Auditor (RA) improper payment findings. Who do I contact if I have a question or concern on a RA improper payment?

You would contact your RA. For Region D (HDI) you would contact the appropriate Provider Service number: Part A 866-590-5598 Part B 866-376-2319

What are the different types of letters that my facility will receive related to improper payments?

The letters the RACs will send vary by whether it has identified an improper payment by automated or complex review. For automated reviews, providers will receive an informational letter beginning 1/3/12. For complex reviews, providers will receive a medical record request letter and a review results letter. In the event that the review results letter contains a notification of improper payment, a demand letter will then be issued.

What do I do when I receive a demand letter?

You first review the demand letter and Medicare regulation to understand the improper payment determination. To avoid any interest assessment, you should refund the monies within 30 days from the date of the demand letter; you have the option of issuing a check or requesting immediate offset by the Medicare Claims Processing Contractor. You may also have the amount recouped by taking no action after the receipt of the demand letter. If you choose recoupment, interest will be assessed after the 30th day. If you have additional information or disagree with the demand letter there are options available to you. You may file a Discussion (with the RA) by following the directions on your demand letter; or, you may file an appeal (with the Medicare Claims Processing Contractor), which if done within 30 days, stops recoupment. We strongly urge providers to submit any documentation or information relating to a Discussion with the RAC as soon as possible.

Providers have received notification that the Medicare Administrative Contractors (MACs) will begin issuing the demand letter on the Recovery Auditor (RA) improper payment findings. Will the MAC be sending out the demand letter on both the automated and complex RA reviews?

Yes. The MAC will be issuing the demand letters for all types of RA reviews

Providers have received notification that the Medicare Administrative Contractors (MACs) will begin issuing the demand letter on the Recovery Auditor (RA) improper payment findings. Who will issue the Underpayment Notification Letter?

The RAs will continue to issue the Underpayment Notification Letters.

Providers have received notification that the Medicare Administrative Contractors (MACs) will begin issuing the demand letter on the Recovery Auditor (RA) improper payment findings. Will I receive any notification of an improper finding from the RA?

Yes. The RA will continue to send Review Results letters on complex reviews and Informational Letters on automated and semi-automated reviews. The Informational Letters will supply the majority of the audit detail previously supplied with the demand letter on automated and semi-automated reviews. The Review Results and Informational Letter will be sent to the designated address listed on the HDI Provider Portal.

Providers have received notification that the Medicare Administrative Contractors (MACs) will begin issuing the demand letter on the Recovery Auditor (RA) improper payment findings. Who do I contact if I believe I should have received a demand letter but have not received it yet (after 1/3/2012)?

You would contact the Customer Service area at your MAC.

Providers have received notification that the Medicare Administrative Contractors (MACs) will begin issuing the demand letter on the Recovery Auditor (RA) improper payment findings. Who do I contact if I have a question or concern on a RA improper payment?

You would contact your RA. For Region D (HDI) you would contact the appropriate Provider Service number: Part A 866-590-5598 Part B 866-376-2319

What are the different types of letters that my facility will receive related to improper payments?

The letters the RACs will send vary by whether it has identified an improper payment by automated or complex review. For automated reviews, providers will receive an informational letter beginning 1/3/12. For complex reviews, providers will receive a medical record request letter and a review results letter. In the event that the review results letter contains a notification of improper payment, a demand letter will then be issued.

What do I do when I receive a demand letter?

You first review the demand letter and Medicare regulation to understand the improper payment determination. To avoid any interest assessment, you should refund the monies within 30 days from the date of the demand letter; you have the option of issuing a check or requesting immediate offset by the Medicare Claims Processing Contractor. You may also have the amount recouped by taking no action after the receipt of the demand letter. If you choose recoupment, interest will be assessed after the 30th day. If you have additional information or disagree with the demand letter there are options available to you. You may file a Discussion (with the RA) by following the directions on your demand letter; or, you may file an appeal (with the Medicare Claims Processing Contractor), which if done within 30 days, stops recoupment. We strongly urge providers to submit any documentation or information relating to a Discussion with the RAC as soon as possible.

Providers have received notification that the Medicare Administrative Contractors (MACs) will begin issuing the demand letter on the Recovery Auditor (RA) improper payment findings. Will the MAC be sending out the demand letter on both the automated and complex RA reviews?

Yes. The MAC will be issuing the demand letters for all types of RA reviews

Providers have received notification that the Medicare Administrative Contractors (MACs) will begin issuing the demand letter on the Recovery Auditor (RA) improper payment findings. Who will issue the Underpayment Notification Letter?

The RAs will continue to issue the Underpayment Notification Letters.

Providers have received notification that the Medicare Administrative Contractors (MACs) will begin issuing the demand letter on the Recovery Auditor (RA) improper payment findings. Will I receive any notification of an improper finding from the RA?

Yes. The RA will continue to send Review Results letters on complex reviews and Informational Letters on automated and semi-automated reviews. The Informational Letters will supply the majority of the audit detail previously supplied with the demand letter on automated and semi-automated reviews. The Review Results and Informational Letter will be sent to the designated address listed on the HDI Provider Portal.

Providers have received notification that the Medicare Administrative Contractors (MACs) will begin issuing the demand letter on the Recovery Auditor (RA) improper payment findings. Who do I contact if I believe I should have received a demand letter but have not received it yet (after 1/3/2012)?

You would contact the Customer Service area at your MAC.

Providers have received notification that the Medicare Administrative Contractors (MACs) will begin issuing the demand letter on the Recovery Auditor (RA) improper payment findings. Who do I contact if I have a question or concern on a RA improper payment?

You would contact your RA. For Region D (HDI) you would contact the appropriate Provider Service number: Part A 866-590-5598 Part B 866-376-2319

What are the different types of letters that my facility will receive related to improper payments?

The letters the RACs will send vary by whether it has identified an improper payment by automated or complex review. For automated reviews, providers will receive an informational letter beginning 1/3/12. For complex reviews, providers will receive a medical record request letter and a review results letter. In the event that the review results letter contains a notification of improper payment, a demand letter will then be issued.

What do I do when I receive a demand letter?

You first review the demand letter and Medicare regulation to understand the improper payment determination. To avoid any interest assessment, you should refund the monies within 30 days from the date of the demand letter; you have the option of issuing a check or requesting immediate offset by the Medicare Claims Processing Contractor. You may also have the amount recouped by taking no action after the receipt of the demand letter. If you choose recoupment, interest will be assessed after the 30th day. If you have additional information or disagree with the demand letter there are options available to you. You may file a Discussion (with the RA) by following the directions on your demand letter; or, you may file an appeal (with the Medicare Claims Processing Contractor), which if done within 30 days, stops recoupment. We strongly urge providers to submit any documentation or information relating to a Discussion with the RAC as soon as possible.

Providers have received notification that the Medicare Administrative Contractors (MACs) will begin issuing the demand letter on the Recovery Auditor (RA) improper payment findings. Will the MAC be sending out the demand letter on both the automated and complex RA reviews?

Yes. The MAC will be issuing the demand letters for all types of RA reviews

Providers have received notification that the Medicare Administrative Contractors (MACs) will begin issuing the demand letter on the Recovery Auditor (RA) improper payment findings. Who will issue the Underpayment Notification Letter?

The RAs will continue to issue the Underpayment Notification Letters.

Providers have received notification that the Medicare Administrative Contractors (MACs) will begin issuing the demand letter on the Recovery Auditor (RA) improper payment findings. Will I receive any notification of an improper finding from the RA?

Yes. The RA will continue to send Review Results letters on complex reviews and Informational Letters on automated and semi-automated reviews. The Informational Letters will supply the majority of the audit detail previously supplied with the demand letter on automated and semi-automated reviews. The Review Results and Informational Letter will be sent to the designated address listed on the HDI Provider Portal.

Providers have received notification that the Medicare Administrative Contractors (MACs) will begin issuing the demand letter on the Recovery Auditor (RA) improper payment findings. Who do I contact if I believe I should have received a demand letter but have not received it yet (after 1/3/2012)?

You would contact the Customer Service area at your MAC.

Providers have received notification that the Medicare Administrative Contractors (MACs) will begin issuing the demand letter on the Recovery Auditor (RA) improper payment findings. Who do I contact if I have a question or concern on a RA improper payment?

You would contact your RA. For Region D (HDI) you would contact the appropriate Provider Service number: Part A 866-590-5598 Part B 866-376-2319

What are the different types of letters that my facility will receive related to improper payments?

The letters the RACs will send vary by whether it has identified an improper payment by automated or complex review. For automated reviews, providers will receive an informational letter beginning 1/3/12. For complex reviews, providers will receive a medical record request letter and a review results letter. In the event that the review results letter contains a notification of improper payment, a demand letter will then be issued.

What do I do when I receive a demand letter?

You first review the demand letter and Medicare regulation to understand the improper payment determination. To avoid any interest assessment, you should refund the monies within 30 days from the date of the demand letter; you have the option of issuing a check or requesting immediate offset by the Medicare Claims Processing Contractor. You may also have the amount recouped by taking no action after the receipt of the demand letter. If you choose recoupment, interest will be assessed after the 30th day. If you have additional information or disagree with the demand letter there are options available to you. You may file a Discussion (with the RA) by following the directions on your demand letter; or, you may file an appeal (with the Medicare Claims Processing Contractor), which if done within 30 days, stops recoupment. We strongly urge providers to submit any documentation or information relating to a Discussion with the RAC as soon as possible.

Providers have received notification that the Medicare Administrative Contractors (MACs) will begin issuing the demand letter on the Recovery Auditor (RA) improper payment findings. Will the MAC be sending out the demand letter on both the automated and complex RA reviews?

Yes. The MAC will be issuing the demand letters for all types of RA reviews

Providers have received notification that the Medicare Administrative Contractors (MACs) will begin issuing the demand letter on the Recovery Auditor (RA) improper payment findings. Who will issue the Underpayment Notification Letter?

The RAs will continue to issue the Underpayment Notification Letters.

Providers have received notification that the Medicare Administrative Contractors (MACs) will begin issuing the demand letter on the Recovery Auditor (RA) improper payment findings. Will I receive any notification of an improper finding from the RA?

Yes. The RA will continue to send Review Results letters on complex reviews and Informational Letters on automated and semi-automated reviews. The Informational Letters will supply the majority of the audit detail previously supplied with the demand letter on automated and semi-automated reviews. The Review Results and Informational Letter will be sent to the designated address listed on the HDI Provider Portal.

Providers have received notification that the Medicare Administrative Contractors (MACs) will begin issuing the demand letter on the Recovery Auditor (RA) improper payment findings. Who do I contact if I believe I should have received a demand letter but have not received it yet (after 1/3/2012)?

You would contact the Customer Service area at your MAC.

Providers have received notification that the Medicare Administrative Contractors (MACs) will begin issuing the demand letter on the Recovery Auditor (RA) improper payment findings. Who do I contact if I have a question or concern on a RA improper payment?

You would contact your RA. For Region D (HDI) you would contact the appropriate Provider Service number: Part A 866-590-5598 Part B 866-376-2319

What are the different types of letters that my facility will receive related to improper payments?

The letters the RACs will send vary by whether it has identified an improper payment by automated or complex review. For automated reviews, providers will receive an informational letter beginning 1/3/12. For complex reviews, providers will receive a medical record request letter and a review results letter. In the event that the review results letter contains a notification of improper payment, a demand letter will then be issued.

What do I do when I receive a demand letter?

You first review the demand letter and Medicare regulation to understand the improper payment determination. To avoid any interest assessment, you should refund the monies within 30 days from the date of the demand letter; you have the option of issuing a check or requesting immediate offset by the Medicare Claims Processing Contractor. You may also have the amount recouped by taking no action after the receipt of the demand letter. If you choose recoupment, interest will be assessed after the 30th day. If you have additional information or disagree with the demand letter there are options available to you. You may file a Discussion (with the RA) by following the directions on your demand letter; or, you may file an appeal (with the Medicare Claims Processing Contractor), which if done within 30 days, stops recoupment. We strongly urge providers to submit any documentation or information relating to a Discussion with the RAC as soon as possible.

Providers have received notification that the Medicare Administrative Contractors (MACs) will begin issuing the demand letter on the Recovery Auditor (RA) improper payment findings. Will the MAC be sending out the demand letter on both the automated and complex RA reviews?

Yes. The MAC will be issuing the demand letters for all types of RA reviews

Providers have received notification that the Medicare Administrative Contractors (MACs) will begin issuing the demand letter on the Recovery Auditor (RA) improper payment findings. Who will issue the Underpayment Notification Letter?

The RAs will continue to issue the Underpayment Notification Letters.

Providers have received notification that the Medicare Administrative Contractors (MACs) will begin issuing the demand letter on the Recovery Auditor (RA) improper payment findings. Will I receive any notification of an improper finding from the RA?

Yes. The RA will continue to send Review Results letters on complex reviews and Informational Letters on automated and semi-automated reviews. The Informational Letters will supply the majority of the audit detail previously supplied with the demand letter on automated and semi-automated reviews. The Review Results and Informational Letter will be sent to the designated address listed on the HDI Provider Portal.

Providers have received notification that the Medicare Administrative Contractors (MACs) will begin issuing the demand letter on the Recovery Auditor (RA) improper payment findings. Who do I contact if I believe I should have received a demand letter but have not received it yet (after 1/3/2012)?

You would contact the Customer Service area at your MAC.

Providers have received notification that the Medicare Administrative Contractors (MACs) will begin issuing the demand letter on the Recovery Auditor (RA) improper payment findings. Who do I contact if I have a question or concern on a RA improper payment?

You would contact your RA. For Region D (HDI) you would contact the appropriate Provider Service number: Part A 866-590-5598 Part B 866-376-2319

What are the different types of letters that my facility will receive related to improper payments?

The letters the RACs will send vary by whether it has identified an improper payment by automated or complex review. For automated reviews, providers will receive an informational letter beginning 1/3/12. For complex reviews, providers will receive a medical record request letter and a review results letter. In the event that the review results letter contains a notification of improper payment, a demand letter will then be issued.

What do I do when I receive a demand letter?

You first review the demand letter and Medicare regulation to understand the improper payment determination. To avoid any interest assessment, you should refund the monies within 30 days from the date of the demand letter; you have the option of issuing a check or requesting immediate offset by the Medicare Claims Processing Contractor. You may also have the amount recouped by taking no action after the receipt of the demand letter. If you choose recoupment, interest will be assessed after the 30th day. If you have additional information or disagree with the demand letter there are options available to you. You may file a Discussion (with the RA) by following the directions on your demand letter; or, you may file an appeal (with the Medicare Claims Processing Contractor), which if done within 30 days, stops recoupment. We strongly urge providers to submit any documentation or information relating to a Discussion with the RAC as soon as possible.

Providers have received notification that the Medicare Administrative Contractors (MACs) will begin issuing the demand letter on the Recovery Auditor (RA) improper payment findings. Will the MAC be sending out the demand letter on both the automated and complex RA reviews?

Yes. The MAC will be issuing the demand letters for all types of RA reviews

Providers have received notification that the Medicare Administrative Contractors (MACs) will begin issuing the demand letter on the Recovery Auditor (RA) improper payment findings. Who will issue the Underpayment Notification Letter?

The RAs will continue to issue the Underpayment Notification Letters.

Providers have received notification that the Medicare Administrative Contractors (MACs) will begin issuing the demand letter on the Recovery Auditor (RA) improper payment findings. Will I receive any notification of an improper finding from the RA?

Yes. The RA will continue to send Review Results letters on complex reviews and Informational Letters on automated and semi-automated reviews. The Informational Letters will supply the majority of the audit detail previously supplied with the demand letter on automated and semi-automated reviews. The Review Results and Informational Letter will be sent to the designated address listed on the HDI Provider Portal.

Providers have received notification that the Medicare Administrative Contractors (MACs) will begin issuing the demand letter on the Recovery Auditor (RA) improper payment findings. Who do I contact if I believe I should have received a demand letter but have not received it yet (after 1/3/2012)?

You would contact the Customer Service area at your MAC.

Providers have received notification that the Medicare Administrative Contractors (MACs) will begin issuing the demand letter on the Recovery Auditor (RA) improper payment findings. Who do I contact if I have a question or concern on a RA improper payment?

You would contact your RA. For Region D (HDI) you would contact the appropriate Provider Service number: Part A 866-590-5598 Part B 866-376-2319

What are the different types of letters that my facility will receive related to improper payments?

The letters the RACs will send vary by whether it has identified an improper payment by automated or complex review. For automated reviews, providers will receive an informational letter beginning 1/3/12. For complex reviews, providers will receive a medical record request letter and a review results letter. In the event that the review results letter contains a notification of improper payment, a demand letter will then be issued.

What do I do when I receive a demand letter?

You first review the demand letter and Medicare regulation to understand the improper payment determination. To avoid any interest assessment, you should refund the monies within 30 days from the date of the demand letter; you have the option of issuing a check or requesting immediate offset by the Medicare Claims Processing Contractor. You may also have the amount recouped by taking no action after the receipt of the demand letter. If you choose recoupment, interest will be assessed after the 30th day. If you have additional information or disagree with the demand letter there are options available to you. You may file a Discussion (with the RA) by following the directions on your demand letter; or, you may file an appeal (with the Medicare Claims Processing Contractor), which if done within 30 days, stops recoupment. We strongly urge providers to submit any documentation or information relating to a Discussion with the RAC as soon as possible.

Providers have received notification that the Medicare Administrative Contractors (MACs) will begin issuing the demand letter on the Recovery Auditor (RA) improper payment findings. Will the MAC be sending out the demand letter on both the automated and complex RA reviews?

Yes. The MAC will be issuing the demand letters for all types of RA reviews

Providers have received notification that the Medicare Administrative Contractors (MACs) will begin issuing the demand letter on the Recovery Auditor (RA) improper payment findings. Who will issue the Underpayment Notification Letter?

The RAs will continue to issue the Underpayment Notification Letters.

Providers have received notification that the Medicare Administrative Contractors (MACs) will begin issuing the demand letter on the Recovery Auditor (RA) improper payment findings. Will I receive any notification of an improper finding from the RA?

Yes. The RA will continue to send Review Results letters on complex reviews and Informational Letters on automated and semi-automated reviews. The Informational Letters will supply the majority of the audit detail previously supplied with the demand letter on automated and semi-automated reviews. The Review Results and Informational Letter will be sent to the designated address listed on the HDI Provider Portal.

Providers have received notification that the Medicare Administrative Contractors (MACs) will begin issuing the demand letter on the Recovery Auditor (RA) improper payment findings. Who do I contact if I believe I should have received a demand letter but have not received it yet (after 1/3/2012)?

You would contact the Customer Service area at your MAC.

Providers have received notification that the Medicare Administrative Contractors (MACs) will begin issuing the demand letter on the Recovery Auditor (RA) improper payment findings. Who do I contact if I have a question or concern on a RA improper payment?

You would contact your RA. For Region D (HDI) you would contact the appropriate Provider Service number: Part A 866-590-5598 Part B 866-376-2319

What are the different types of letters that my facility will receive related to improper payments?

The letters the RACs will send vary by whether it has identified an improper payment by automated or complex review. For automated reviews, providers will receive an informational letter beginning 1/3/12. For complex reviews, providers will receive a medical record request letter and a review results letter. In the event that the review results letter contains a notification of improper payment, a demand letter will then be issued.

What do I do when I receive a demand letter?

You first review the demand letter and Medicare regulation to understand the improper payment determination. To avoid any interest assessment, you should refund the monies within 30 days from the date of the demand letter; you have the option of issuing a check or requesting immediate offset by the Medicare Claims Processing Contractor. You may also have the amount recouped by taking no action after the receipt of the demand letter. If you choose recoupment, interest will be assessed after the 30th day. If you have additional information or disagree with the demand letter there are options available to you. You may file a Discussion (with the RA) by following the directions on your demand letter; or, you may file an appeal (with the Medicare Claims Processing Contractor), which if done within 30 days, stops recoupment. We strongly urge providers to submit any documentation or information relating to a Discussion with the RAC as soon as possible.

Providers have received notification that the Medicare Administrative Contractors (MACs) will begin issuing the demand letter on the Recovery Auditor (RA) improper payment findings. Will the MAC be sending out the demand letter on both the automated and complex RA reviews?

Yes. The MAC will be issuing the demand letters for all types of RA reviews

Providers have received notification that the Medicare Administrative Contractors (MACs) will begin issuing the demand letter on the Recovery Auditor (RA) improper payment findings. Who will issue the Underpayment Notification Letter?

The RAs will continue to issue the Underpayment Notification Letters.

Providers have received notification that the Medicare Administrative Contractors (MACs) will begin issuing the demand letter on the Recovery Auditor (RA) improper payment findings. Will I receive any notification of an improper finding from the RA?

Yes. The RA will continue to send Review Results letters on complex reviews and Informational Letters on automated and semi-automated reviews. The Informational Letters will supply the majority of the audit detail previously supplied with the demand letter on automated and semi-automated reviews. The Review Results and Informational Letter will be sent to the designated address listed on the HDI Provider Portal.

Providers have received notification that the Medicare Administrative Contractors (MACs) will begin issuing the demand letter on the Recovery Auditor (RA) improper payment findings. Who do I contact if I believe I should have received a demand letter but have not received it yet (after 1/3/2012)?

You would contact the Customer Service area at your MAC.

Providers have received notification that the Medicare Administrative Contractors (MACs) will begin issuing the demand letter on the Recovery Auditor (RA) improper payment findings. Who do I contact if I have a question or concern on a RA improper payment?

You would contact your RA. For Region D (HDI) you would contact the appropriate Provider Service number: Part A 866-590-5598 Part B 866-376-2319

What types of improper payments is HDI looking for?

HDI is tasked to review the claims data that it receives from CMS for both underpayments and overpayments in the Medicare fee-for-service program, including incorrect payment amounts, non-covered services, incorrectly coded services, and duplicate services.

What determines whether an automated or complex review is performed?

The type of review is determined by the CMS New Issue Review Process. All new improper payment issues that HDI develops must first be approved by CMS and posted on HDI’s RAC provider website prior to HDI mailing correspondence to providers.

How far back can HDI go in reviewing claims?

The RAC shall not attempt to identify any overpayment or underpayment more than 3 years past the date of the initial determination made on the claim. The initial determination date is defined as the claim paid date. The RAC program will begin with claims paid on or after October 1, 2007.

Can I appeal an underpayment?

If you do not agree with an underpayment determination, you can inform HDI that you do not wish to receive it and HDI will close the claim.

What types of improper payments is HDI looking for?

HDI is tasked to review the claims data that it receives from CMS for both underpayments and overpayments in the Medicare fee-for-service program, including incorrect payment amounts, non-covered services, incorrectly coded services, and duplicate services.

What determines whether an automated or complex review is performed?

The type of review is determined by the CMS New Issue Review Process. All new improper payment issues that HDI develops must first be approved by CMS and posted on HDI’s RAC provider website prior to HDI mailing correspondence to providers.

How far back can HDI go in reviewing claims?

The RAC shall not attempt to identify any overpayment or underpayment more than 3 years past the date of the initial determination made on the claim. The initial determination date is defined as the claim paid date. The RAC program will begin with claims paid on or after October 1, 2007.

Can I appeal an underpayment?

If you do not agree with an underpayment determination, you can inform HDI that you do not wish to receive it and HDI will close the claim.

What types of improper payments is HDI looking for?

HDI is tasked to review the claims data that it receives from CMS for both underpayments and overpayments in the Medicare fee-for-service program, including incorrect payment amounts, non-covered services, incorrectly coded services, and duplicate services.

What determines whether an automated or complex review is performed?

The type of review is determined by the CMS New Issue Review Process. All new improper payment issues that HDI develops must first be approved by CMS and posted on HDI’s RAC provider website prior to HDI mailing correspondence to providers.

How far back can HDI go in reviewing claims?

The RAC shall not attempt to identify any overpayment or underpayment more than 3 years past the date of the initial determination made on the claim. The initial determination date is defined as the claim paid date. The RAC program will begin with claims paid on or after October 1, 2007.

Can I appeal an underpayment?

If you do not agree with an underpayment determination, you can inform HDI that you do not wish to receive it and HDI will close the claim.

What types of improper payments is HDI looking for?

HDI is tasked to review the claims data that it receives from CMS for both underpayments and overpayments in the Medicare fee-for-service program, including incorrect payment amounts, non-covered services, incorrectly coded services, and duplicate services.

What determines whether an automated or complex review is performed?

The type of review is determined by the CMS New Issue Review Process. All new improper payment issues that HDI develops must first be approved by CMS and posted on HDI’s RAC provider website prior to HDI mailing correspondence to providers.

How far back can HDI go in reviewing claims?

The RAC shall not attempt to identify any overpayment or underpayment more than 3 years past the date of the initial determination made on the claim. The initial determination date is defined as the claim paid date. The RAC program will begin with claims paid on or after October 1, 2007.

Can I appeal an underpayment?

If you do not agree with an underpayment determination, you can inform HDI that you do not wish to receive it and HDI will close the claim.

What types of improper payments is HDI looking for?

HDI is tasked to review the claims data that it receives from CMS for both underpayments and overpayments in the Medicare fee-for-service program, including incorrect payment amounts, non-covered services, incorrectly coded services, and duplicate services.

What determines whether an automated or complex review is performed?

The type of review is determined by the CMS New Issue Review Process. All new improper payment issues that HDI develops must first be approved by CMS and posted on HDI’s RAC provider website prior to HDI mailing correspondence to providers.

How far back can HDI go in reviewing claims?

The RAC shall not attempt to identify any overpayment or underpayment more than 3 years past the date of the initial determination made on the claim. The initial determination date is defined as the claim paid date. The RAC program will begin with claims paid on or after October 1, 2007.

Can I appeal an underpayment?

If you do not agree with an underpayment determination, you can inform HDI that you do not wish to receive it and HDI will close the claim.

How long does HDI have to review the records I have sent?

In virtually all circumstances, HDI will complete its reviews within 60 days. You will receive a notification of the review results for every complex review.

Will I be reimbursed for the cost of producing the medical records?

In circumstances where reimbursement for photocopying/imaging and postage is warranted, HDI will reimburse providers as required by 42 CFR § 476.78(c). HDI will reimburse for medical records and first class postage associated with acute care inpatient prospective payment system (PPS) hospital (DRG) claims, and long term care hospital claims, in accordance with the applicable payment formula. HDI does not reimburse for the cost of courier services such as FedEx or UPS. The current per page reimbursement rate for photocopying medical records is $.12 per page for PPS records, plus first class postage (HDI does not reimburse for the expense of courier services such as FedEx or UPS. Any records sent using such courier services is at the expense of the provider). Hospitals and other providers under a Medicare cost reimbursement system receive no photocopying reimbursement. Capitation providers, such as HMOs and dialysis facilities, will receive $.12 per page. Non-PPS acute care providers will receive $.15 per page.

What are my options for sending medical records?

At this time, you can send paper copies via first class U.S. mail (HDI does not reimburse for the expense of courier services such as FedEx or UPS. Any records sent using such courier services is at the expense of the provider), fax, or scanned images sent via an encrypted CD/DVD. Instructions and submission options will be supplied in HDI’s medical record request letter.

How long does HDI have to review the records I have sent?

In virtually all circumstances, HDI will complete its reviews within 60 days. You will receive a notification of the review results for every complex review.

Will I be reimbursed for the cost of producing the medical records?

In circumstances where reimbursement for photocopying/imaging and postage is warranted, HDI will reimburse providers as required by 42 CFR § 476.78(c). HDI will reimburse for medical records and first class postage associated with acute care inpatient prospective payment system (PPS) hospital (DRG) claims, and long term care hospital claims, in accordance with the applicable payment formula. HDI does not reimburse for the cost of courier services such as FedEx or UPS. The current per page reimbursement rate for photocopying medical records is $.12 per page for PPS records, plus first class postage (HDI does not reimburse for the expense of courier services such as FedEx or UPS. Any records sent using such courier services is at the expense of the provider). Hospitals and other providers under a Medicare cost reimbursement system receive no photocopying reimbursement. Capitation providers, such as HMOs and dialysis facilities, will receive $.12 per page. Non-PPS acute care providers will receive $.15 per page.

What are my options for sending medical records?

At this time, you can send paper copies via first class U.S. mail (HDI does not reimburse for the expense of courier services such as FedEx or UPS. Any records sent using such courier services is at the expense of the provider), fax, or scanned images sent via an encrypted CD/DVD. Instructions and submission options will be supplied in HDI’s medical record request letter.

How long does HDI have to review the records I have sent?

In virtually all circumstances, HDI will complete its reviews within 60 days. You will receive a notification of the review results for every complex review.

Will I be reimbursed for the cost of producing the medical records?

In circumstances where reimbursement for photocopying/imaging and postage is warranted, HDI will reimburse providers as required by 42 CFR § 476.78(c). HDI will reimburse for medical records and first class postage associated with acute care inpatient prospective payment system (PPS) hospital (DRG) claims, and long term care hospital claims, in accordance with the applicable payment formula. HDI does not reimburse for the cost of courier services such as FedEx or UPS. The current per page reimbursement rate for photocopying medical records is $.12 per page for PPS records, plus first class postage (HDI does not reimburse for the expense of courier services such as FedEx or UPS. Any records sent using such courier services is at the expense of the provider). Hospitals and other providers under a Medicare cost reimbursement system receive no photocopying reimbursement. Capitation providers, such as HMOs and dialysis facilities, will receive $.12 per page. Non-PPS acute care providers will receive $.15 per page.

What are my options for sending medical records?

At this time, you can send paper copies via first class U.S. mail (HDI does not reimburse for the expense of courier services such as FedEx or UPS. Any records sent using such courier services is at the expense of the provider), fax, or scanned images sent via an encrypted CD/DVD. Instructions and submission options will be supplied in HDI’s medical record request letter.

How long does HDI have to review the records I have sent?

In virtually all circumstances, HDI will complete its reviews within 60 days. You will receive a notification of the review results for every complex review.

Will I be reimbursed for the cost of producing the medical records?

In circumstances where reimbursement for photocopying/imaging and postage is warranted, HDI will reimburse providers as required by 42 CFR § 476.78(c). HDI will reimburse for medical records and first class postage associated with acute care inpatient prospective payment system (PPS) hospital (DRG) claims, and long term care hospital claims, in accordance with the applicable payment formula. HDI does not reimburse for the cost of courier services such as FedEx or UPS. The current per page reimbursement rate for photocopying medical records is $.12 per page for PPS records, plus first class postage (HDI does not reimburse for the expense of courier services such as FedEx or UPS. Any records sent using such courier services is at the expense of the provider). Hospitals and other providers under a Medicare cost reimbursement system receive no photocopying reimbursement. Capitation providers, such as HMOs and dialysis facilities, will receive $.12 per page. Non-PPS acute care providers will receive $.15 per page.

What are my options for sending medical records?

At this time, you can send paper copies via first class U.S. mail (HDI does not reimburse for the expense of courier services such as FedEx or UPS. Any records sent using such courier services is at the expense of the provider), fax, or scanned images sent via an encrypted CD/DVD. Instructions and submission options will be supplied in HDI’s medical record request letter.

What states are included in HDI’s region?

Alaska, Arizona, California, South Dakota, North Dakota, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, Oregon, Utah, Washington and Wyoming

I know the RAC can review claims up to 3 years. Please explain how the 3 years period is determined.

Neither overpayments nor underpayments can be audited more than three (3) years past the initial claims paid date. • For complex reviews (where medical records are requested), the “look back” period is calculated by starting with the date the initial claim is paid and ends with the date the RAC issues the medical record request. Complex Review EXAMPLE: Claim date of service = 9/01-9/04/2007. Initial Claim payment date is = 10/4/2007. The RAC has up to 3 years from the initial claim paid date of 10/4/2007 to issue a medical record request (e.g., until 10/4/2010). If a medical request DATED on or before 10/4/2010 is received, it is within the “look back” period and the provider should promptly respond to the request. • For automated reviews, the “look back” period is calculated by starting with the initial claims paid date and ends with the date of the overpayment notification letter. Automated Review EXAMPLE: Claim date of service = 8/12/2007 Initial Claim payment date is = 1/18/2008 The RAC has up to 3 years from the initial claim paid date (1/18/2008) to issue a Demand Letter request (e.g., until 1/18/2011). If a Demand Letter DATED on or before 1/18/2011 is received, it is within the “look back” period and the provider should promptly respond to the request.

What is your Provider Relations toll-free number?

HDI’s contact numbers are as follows: Part A/Hospice: 866.590.5598 Part B/DME: 866.376.2319 Fax: Hospital & Hospice: 702.240.5595 Physician/DME: 702.240.5510

Why is the Knowledge Based Authentication (KBA) process used?

CMS has directed HealthDataInsights, Inc. (“HDI”) to allow providers to use a Knowledge Based Authentication method in order to securely access the HDI provider portal. The provider portal contains contact information for providers and enables providers to customize their contact information. It also contains the additional document request information as well as the receipt and review status of those records.

When does a provider need to use the Knowledge Based Authentication (KBA) to access the provider portal?

Part A Inpatient Hospitals (acute providers) were mailed a user name and password to access the HDI provider portal in 2009. If you already have a user name and password, it is not necessary to utilize the KBA method. Providers with a user name and password may sign in under “Provider Sign In”, located on the right side of the Login page. All other providers must initially utilize the Knowledge Based Authentication process to establish a password and gain access to the provider portal

What information can I access in the HDI Provider Portal?

After the login process, you have the ability to view and change contact information, view HDI requests for medical records and view the tracking of the medical records received.

How do I change/update provider contact information?

After the login process, you access the Account Management header and use the drop down box for Contact Information. Three columns of information appear. The first column is the Address from the Claims Processing Contractor (CPC) and can not be edited. The second column is the Contact to Receive Medical Record Request Letters. You may edit or delete contact information from this column. If you delete this information the contact will default to the CPC contact information. The third column is the Contact to Receive Improper Payment Letters. You may edit or delete contact information from this column as well. If you delete this information the contact will default to the CPC contact information. “Add Web Users” is found at the bottom of this page and allows up to a total of 7 Web Users. Please remember that any contact information in column 2 and/or column three is included in this total so if both columns are completed (even with the same information) you may only add 5 additional Web Users.

How do I track the status of the medical records I have sent to HDI?

After the login process, you access the Medical Record Tracking header. You are then directed to the Medical Record Tracking screen which provides the RAC Case ID, Medical Record Number, Date of Service From, Date of Service To, Documentation Requested (which indicates the date HDI requested the documentation), Documentation Received (which indicated the date HDI received the documentation), Review Results Letter Sent (which indicates the date the Review Results Letter was sent from HDI).

What is a Discussion period?

The Discussion period begins on the date set forth on the demand letter for automated reviews, or the date of the review results letter for complex reviews, and continues through the date the Claims Processing Contractor (“CPC”) recoups the amount (up to 41 days). The Discussion period offers Providers and Suppliers the opportunity to review the findings, and to provide HDI with additional information and/or documentation prior to recoupment by the CPC.

How do I open a Discussion with the RAC?

Before you can open a Discussion, you must have a demand letter (for automated reviews) or a review results letter (for complex reviews). Then, you obtain the Discussion form from the HDI provider portal at www.racinfo.healthdatainsights.com. The Discussion form is the first item after selecting the Provider Information tab. Fill in the information requested and submit any documentation and information that is pertinent to your case, to indicate why HDI should reconsider the finding. Fax the form and any documentation to HDI at (702) 240-5595 for Part A and (702) 240-5510 for Part B Discussions. If you do not have a demand letter or a review results letter, but have concerns or questions, please contact our customer service area at the appropriate number below: Part A Providers, including Hospital, SNF and Hospice Telephone: (866) 590-5598 Fax: (702) 240-5595 Part B and DME Providers Telephone: (866) 376-2319 Fax: (702) 240-5510

What happens to the documentation and information that is submitted with the Discussion form?

The documentation and information is reviewed by the appropriate person at HDI and a determination is made to either uphold or overturn the overpayment. A letter is sent to the provider advising them of the determination. If HDI closes the finding after review of the Discussion information, HDI will work with the Medicare Claims Processing Contractor to close the AR or refund the monies if the offset has already occurred. The Discussion process does not impact the Medicare Claim Processing Contractor rebuttal or appeal process and does not stop recoupment.

How do I know that an account has been recouped?

The Medicare Claims Processing Contractor (“CPC”) will notify the provider via a Remittance Advice (“RA”) that it has established an Account Receivable (“AR”). The amount will be identified on the original RA as code N432. That is an indication that an AR has been set up and, if not paid back in 41 days, the CPC will recoup the amount with interest. After expiration of the forty one (41) day period, if payment is not made, the CPC will send a second RA in the amount that was recouped. We recommend that you retain the original RA for reference purposes.

Why can’t I access or login to my account on the HDI web portal?

For security purposes, providers and suppliers can only access HDI’s web portal using Internet Explorer 7.0, or higher, and Firefox 3.0, or higher. Internet Explorer 7.0 contains critical security updates not contained in earlier versions. If a provider has not upgraded to Internet Explorer 7, which was released in October, 2006, they will need to download the free software to access the web portal.

How will I know what issues the RAC is reviewing?

Once CMS approves an issue for review, HDI places the issue on the HDI website prior to any provider communications. Providers should regularly check the website for new issue updates.

Will HDI review only Medicare Fee for Service claims or will Medicare Advantage Claims also be reviewed?

RACs shall only review Medicare Fee for Service claims.

Why do I need to input my user name and password in the Provider Sign In area of the racinfo.com website to login?

CMS security requirements do not allow the storing of user names and passwords on the Provider Portal. You need to input your user name and password each time you login to the Provider Portal.

What states are included in HDI’s region?

Alaska, Arizona, California, South Dakota, North Dakota, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, Oregon, Utah, Washington and Wyoming

I know the RAC can review claims up to 3 years. Please explain how the 3 years period is determined.

Neither overpayments nor underpayments can be audited more than three (3) years past the initial claims paid date. • For complex reviews (where medical records are requested), the “look back” period is calculated by starting with the date the initial claim is paid and ends with the date the RAC issues the medical record request. Complex Review EXAMPLE: Claim date of service = 9/01-9/04/2007. Initial Claim payment date is = 10/4/2007. The RAC has up to 3 years from the initial claim paid date of 10/4/2007 to issue a medical record request (e.g., until 10/4/2010). If a medical request DATED on or before 10/4/2010 is received, it is within the “look back” period and the provider should promptly respond to the request. • For automated reviews, the “look back” period is calculated by starting with the initial claims paid date and ends with the date of the overpayment notification letter. Automated Review EXAMPLE: Claim date of service = 8/12/2007 Initial Claim payment date is = 1/18/2008 The RAC has up to 3 years from the initial claim paid date (1/18/2008) to issue a Demand Letter request (e.g., until 1/18/2011). If a Demand Letter DATED on or before 1/18/2011 is received, it is within the “look back” period and the provider should promptly respond to the request.

What is your Provider Relations toll-free number?

HDI’s contact numbers are as follows: Part A/Hospice: 866.590.5598 Part B/DME: 866.376.2319 Fax: Hospital & Hospice: 702.240.5595 Physician/DME: 702.240.5510

Why is the Knowledge Based Authentication (KBA) process used?

CMS has directed HealthDataInsights, Inc. (“HDI”) to allow providers to use a Knowledge Based Authentication method in order to securely access the HDI provider portal. The provider portal contains contact information for providers and enables providers to customize their contact information. It also contains the additional document request information as well as the receipt and review status of those records.

When does a provider need to use the Knowledge Based Authentication (KBA) to access the provider portal?

Part A Inpatient Hospitals (acute providers) were mailed a user name and password to access the HDI provider portal in 2009. If you already have a user name and password, it is not necessary to utilize the KBA method. Providers with a user name and password may sign in under “Provider Sign In”, located on the right side of the Login page. All other providers must initially utilize the Knowledge Based Authentication process to establish a password and gain access to the provider portal

What information can I access in the HDI Provider Portal?

After the login process, you have the ability to view and change contact information, view HDI requests for medical records and view the tracking of the medical records received.

How do I change/update provider contact information?

After the login process, you access the Account Management header and use the drop down box for Contact Information. Three columns of information appear. The first column is the Address from the Claims Processing Contractor (CPC) and can not be edited. The second column is the Contact to Receive Medical Record Request Letters. You may edit or delete contact information from this column. If you delete this information the contact will default to the CPC contact information. The third column is the Contact to Receive Improper Payment Letters. You may edit or delete contact information from this column as well. If you delete this information the contact will default to the CPC contact information. “Add Web Users” is found at the bottom of this page and allows up to a total of 7 Web Users. Please remember that any contact information in column 2 and/or column three is included in this total so if both columns are completed (even with the same information) you may only add 5 additional Web Users.

How do I track the status of the medical records I have sent to HDI?

After the login process, you access the Medical Record Tracking header. You are then directed to the Medical Record Tracking screen which provides the RAC Case ID, Medical Record Number, Date of Service From, Date of Service To, Documentation Requested (which indicates the date HDI requested the documentation), Documentation Received (which indicated the date HDI received the documentation), Review Results Letter Sent (which indicates the date the Review Results Letter was sent from HDI).

What is a Discussion period?

The Discussion period begins on the date set forth on the demand letter for automated reviews, or the date of the review results letter for complex reviews, and continues through the date the Claims Processing Contractor (“CPC”) recoups the amount (up to 41 days). The Discussion period offers Providers and Suppliers the opportunity to review the findings, and to provide HDI with additional information and/or documentation prior to recoupment by the CPC.

How do I open a Discussion with the RAC?

Before you can open a Discussion, you must have a demand letter (for automated reviews) or a review results letter (for complex reviews). Then, you obtain the Discussion form from the HDI provider portal at www.racinfo.healthdatainsights.com. The Discussion form is the first item after selecting the Provider Information tab. Fill in the information requested and submit any documentation and information that is pertinent to your case, to indicate why HDI should reconsider the finding. Fax the form and any documentation to HDI at (702) 240-5595 for Part A and (702) 240-5510 for Part B Discussions. If you do not have a demand letter or a review results letter, but have concerns or questions, please contact our customer service area at the appropriate number below: Part A Providers, including Hospital, SNF and Hospice Telephone: (866) 590-5598 Fax: (702) 240-5595 Part B and DME Providers Telephone: (866) 376-2319 Fax: (702) 240-5510

What happens to the documentation and information that is submitted with the Discussion form?

The documentation and information is reviewed by the appropriate person at HDI and a determination is made to either uphold or overturn the overpayment. A letter is sent to the provider advising them of the determination. If HDI closes the finding after review of the Discussion information, HDI will work with the Medicare Claims Processing Contractor to close the AR or refund the monies if the offset has already occurred. The Discussion process does not impact the Medicare Claim Processing Contractor rebuttal or appeal process and does not stop recoupment.

How do I know that an account has been recouped?

The Medicare Claims Processing Contractor (“CPC”) will notify the provider via a Remittance Advice (“RA”) that it has established an Account Receivable (“AR”). The amount will be identified on the original RA as code N432. That is an indication that an AR has been set up and, if not paid back in 41 days, the CPC will recoup the amount with interest. After expiration of the forty one (41) day period, if payment is not made, the CPC will send a second RA in the amount that was recouped. We recommend that you retain the original RA for reference purposes.

Why can’t I access or login to my account on the HDI web portal?

For security purposes, providers and suppliers can only access HDI’s web portal using Internet Explorer 7.0, or higher, and Firefox 3.0, or higher. Internet Explorer 7.0 contains critical security updates not contained in earlier versions. If a provider has not upgraded to Internet Explorer 7, which was released in October, 2006, they will need to download the free software to access the web portal.

How will I know what issues the RAC is reviewing?

Once CMS approves an issue for review, HDI places the issue on the HDI website prior to any provider communications. Providers should regularly check the website for new issue updates.

Will HDI review only Medicare Fee for Service claims or will Medicare Advantage Claims also be reviewed?

RACs shall only review Medicare Fee for Service claims.

Why do I need to input my user name and password in the Provider Sign In area of the racinfo.com website to login?

CMS security requirements do not allow the storing of user names and passwords on the Provider Portal. You need to input your user name and password each time you login to the Provider Portal.

What states are included in HDI’s region?

Alaska, Arizona, California, South Dakota, North Dakota, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, Oregon, Utah, Washington and Wyoming

I know the RAC can review claims up to 3 years. Please explain how the 3 years period is determined.

Neither overpayments nor underpayments can be audited more than three (3) years past the initial claims paid date. • For complex reviews (where medical records are requested), the “look back” period is calculated by starting with the date the initial claim is paid and ends with the date the RAC issues the medical record request. Complex Review EXAMPLE: Claim date of service = 9/01-9/04/2007. Initial Claim payment date is = 10/4/2007. The RAC has up to 3 years from the initial claim paid date of 10/4/2007 to issue a medical record request (e.g., until 10/4/2010). If a medical request DATED on or before 10/4/2010 is received, it is within the “look back” period and the provider should promptly respond to the request. • For automated reviews, the “look back” period is calculated by starting with the initial claims paid date and ends with the date of the overpayment notification letter. Automated Review EXAMPLE: Claim date of service = 8/12/2007 Initial Claim payment date is = 1/18/2008 The RAC has up to 3 years from the initial claim paid date (1/18/2008) to issue a Demand Letter request (e.g., until 1/18/2011). If a Demand Letter DATED on or before 1/18/2011 is received, it is within the “look back” period and the provider should promptly respond to the request.

What is your Provider Relations toll-free number?

HDI’s contact numbers are as follows: Part A/Hospice: 866.590.5598 Part B/DME: 866.376.2319 Fax: Hospital & Hospice: 702.240.5595 Physician/DME: 702.240.5510

Why is the Knowledge Based Authentication (KBA) process used?

CMS has directed HealthDataInsights, Inc. (“HDI”) to allow providers to use a Knowledge Based Authentication method in order to securely access the HDI provider portal. The provider portal contains contact information for providers and enables providers to customize their contact information. It also contains the additional document request information as well as the receipt and review status of those records.

When does a provider need to use the Knowledge Based Authentication (KBA) to access the provider portal?

Part A Inpatient Hospitals (acute providers) were mailed a user name and password to access the HDI provider portal in 2009. If you already have a user name and password, it is not necessary to utilize the KBA method. Providers with a user name and password may sign in under “Provider Sign In”, located on the right side of the Login page. All other providers must initially utilize the Knowledge Based Authentication process to establish a password and gain access to the provider portal

What information can I access in the HDI Provider Portal?

After the login process, you have the ability to view and change contact information, view HDI requests for medical records and view the tracking of the medical records received.

How do I change/update provider contact information?

After the login process, you access the Account Management header and use the drop down box for Contact Information. Three columns of information appear. The first column is the Address from the Claims Processing Contractor (CPC) and can not be edited. The second column is the Contact to Receive Medical Record Request Letters. You may edit or delete contact information from this column. If you delete this information the contact will default to the CPC contact information. The third column is the Contact to Receive Improper Payment Letters. You may edit or delete contact information from this column as well. If you delete this information the contact will default to the CPC contact information. “Add Web Users” is found at the bottom of this page and allows up to a total of 7 Web Users. Please remember that any contact information in column 2 and/or column three is included in this total so if both columns are completed (even with the same information) you may only add 5 additional Web Users.

How do I track the status of the medical records I have sent to HDI?

After the login process, you access the Medical Record Tracking header. You are then directed to the Medical Record Tracking screen which provides the RAC Case ID, Medical Record Number, Date of Service From, Date of Service To, Documentation Requested (which indicates the date HDI requested the documentation), Documentation Received (which indicated the date HDI received the documentation), Review Results Letter Sent (which indicates the date the Review Results Letter was sent from HDI).

What is a Discussion period?

The Discussion period begins on the date set forth on the demand letter for automated reviews, or the date of the review results letter for complex reviews, and continues through the date the Claims Processing Contractor (“CPC”) recoups the amount (up to 41 days). The Discussion period offers Providers and Suppliers the opportunity to review the findings, and to provide HDI with additional information and/or documentation prior to recoupment by the CPC.

How do I open a Discussion with the RAC?

Before you can open a Discussion, you must have a demand letter (for automated reviews) or a review results letter (for complex reviews). Then, you obtain the Discussion form from the HDI provider portal at www.racinfo.healthdatainsights.com. The Discussion form is the first item after selecting the Provider Information tab. Fill in the information requested and submit any documentation and information that is pertinent to your case, to indicate why HDI should reconsider the finding. Fax the form and any documentation to HDI at (702) 240-5595 for Part A and (702) 240-5510 for Part B Discussions. If you do not have a demand letter or a review results letter, but have concerns or questions, please contact our customer service area at the appropriate number below: Part A Providers, including Hospital, SNF and Hospice Telephone: (866) 590-5598 Fax: (702) 240-5595 Part B and DME Providers Telephone: (866) 376-2319 Fax: (702) 240-5510

What happens to the documentation and information that is submitted with the Discussion form?

The documentation and information is reviewed by the appropriate person at HDI and a determination is made to either uphold or overturn the overpayment. A letter is sent to the provider advising them of the determination. If HDI closes the finding after review of the Discussion information, HDI will work with the Medicare Claims Processing Contractor to close the AR or refund the monies if the offset has already occurred. The Discussion process does not impact the Medicare Claim Processing Contractor rebuttal or appeal process and does not stop recoupment.

How do I know that an account has been recouped?

The Medicare Claims Processing Contractor (“CPC”) will notify the provider via a Remittance Advice (“RA”) that it has established an Account Receivable (“AR”). The amount will be identified on the original RA as code N432. That is an indication that an AR has been set up and, if not paid back in 41 days, the CPC will recoup the amount with interest. After expiration of the forty one (41) day period, if payment is not made, the CPC will send a second RA in the amount that was recouped. We recommend that you retain the original RA for reference purposes.

Why can’t I access or login to my account on the HDI web portal?

For security purposes, providers and suppliers can only access HDI’s web portal using Internet Explorer 7.0, or higher, and Firefox 3.0, or higher. Internet Explorer 7.0 contains critical security updates not contained in earlier versions. If a provider has not upgraded to Internet Explorer 7, which was released in October, 2006, they will need to download the free software to access the web portal.

How will I know what issues the RAC is reviewing?

Once CMS approves an issue for review, HDI places the issue on the HDI website prior to any provider communications. Providers should regularly check the website for new issue updates.

Will HDI review only Medicare Fee for Service claims or will Medicare Advantage Claims also be reviewed?

RACs shall only review Medicare Fee for Service claims.

Why do I need to input my user name and password in the Provider Sign In area of the racinfo.com website to login?

CMS security requirements do not allow the storing of user names and passwords on the Provider Portal. You need to input your user name and password each time you login to the Provider Portal.

What states are included in HDI’s region?

Alaska, Arizona, California, South Dakota, North Dakota, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, Oregon, Utah, Washington and Wyoming

I know the RAC can review claims up to 3 years. Please explain how the 3 years period is determined.

Neither overpayments nor underpayments can be audited more than three (3) years past the initial claims paid date. • For complex reviews (where medical records are requested), the “look back” period is calculated by starting with the date the initial claim is paid and ends with the date the RAC issues the medical record request. Complex Review EXAMPLE: Claim date of service = 9/01-9/04/2007. Initial Claim payment date is = 10/4/2007. The RAC has up to 3 years from the initial claim paid date of 10/4/2007 to issue a medical record request (e.g., until 10/4/2010). If a medical request DATED on or before 10/4/2010 is received, it is within the “look back” period and the provider should promptly respond to the request. • For automated reviews, the “look back” period is calculated by starting with the initial claims paid date and ends with the date of the overpayment notification letter. Automated Review EXAMPLE: Claim date of service = 8/12/2007 Initial Claim payment date is = 1/18/2008 The RAC has up to 3 years from the initial claim paid date (1/18/2008) to issue a Demand Letter request (e.g., until 1/18/2011). If a Demand Letter DATED on or before 1/18/2011 is received, it is within the “look back” period and the provider should promptly respond to the request.

What is your Provider Relations toll-free number?

HDI’s contact numbers are as follows: Part A/Hospice: 866.590.5598 Part B/DME: 866.376.2319 Fax: Hospital & Hospice: 702.240.5595 Physician/DME: 702.240.5510

Why is the Knowledge Based Authentication (KBA) process used?

CMS has directed HealthDataInsights, Inc. (“HDI”) to allow providers to use a Knowledge Based Authentication method in order to securely access the HDI provider portal. The provider portal contains contact information for providers and enables providers to customize their contact information. It also contains the additional document request information as well as the receipt and review status of those records.

When does a provider need to use the Knowledge Based Authentication (KBA) to access the provider portal?

Part A Inpatient Hospitals (acute providers) were mailed a user name and password to access the HDI provider portal in 2009. If you already have a user name and password, it is not necessary to utilize the KBA method. Providers with a user name and password may sign in under “Provider Sign In”, located on the right side of the Login page. All other providers must initially utilize the Knowledge Based Authentication process to establish a password and gain access to the provider portal

What information can I access in the HDI Provider Portal?

After the login process, you have the ability to view and change contact information, view HDI requests for medical records and view the tracking of the medical records received.

How do I change/update provider contact information?

After the login process, you access the Account Management header and use the drop down box for Contact Information. Three columns of information appear. The first column is the Address from the Claims Processing Contractor (CPC) and can not be edited. The second column is the Contact to Receive Medical Record Request Letters. You may edit or delete contact information from this column. If you delete this information the contact will default to the CPC contact information. The third column is the Contact to Receive Improper Payment Letters. You may edit or delete contact information from this column as well. If you delete this information the contact will default to the CPC contact information. “Add Web Users” is found at the bottom of this page and allows up to a total of 7 Web Users. Please remember that any contact information in column 2 and/or column three is included in this total so if both columns are completed (even with the same information) you may only add 5 additional Web Users.

How do I track the status of the medical records I have sent to HDI?

After the login process, you access the Medical Record Tracking header. You are then directed to the Medical Record Tracking screen which provides the RAC Case ID, Medical Record Number, Date of Service From, Date of Service To, Documentation Requested (which indicates the date HDI requested the documentation), Documentation Received (which indicated the date HDI received the documentation), Review Results Letter Sent (which indicates the date the Review Results Letter was sent from HDI).

What is a Discussion period?

The Discussion period begins on the date set forth on the demand letter for automated reviews, or the date of the review results letter for complex reviews, and continues through the date the Claims Processing Contractor (“CPC”) recoups the amount (up to 41 days). The Discussion period offers Providers and Suppliers the opportunity to review the findings, and to provide HDI with additional information and/or documentation prior to recoupment by the CPC.

How do I open a Discussion with the RAC?

Before you can open a Discussion, you must have a demand letter (for automated reviews) or a review results letter (for complex reviews). Then, you obtain the Discussion form from the HDI provider portal at www.racinfo.healthdatainsights.com. The Discussion form is the first item after selecting the Provider Information tab. Fill in the information requested and submit any documentation and information that is pertinent to your case, to indicate why HDI should reconsider the finding. Fax the form and any documentation to HDI at (702) 240-5595 for Part A and (702) 240-5510 for Part B Discussions. If you do not have a demand letter or a review results letter, but have concerns or questions, please contact our customer service area at the appropriate number below: Part A Providers, including Hospital, SNF and Hospice Telephone: (866) 590-5598 Fax: (702) 240-5595 Part B and DME Providers Telephone: (866) 376-2319 Fax: (702) 240-5510

What happens to the documentation and information that is submitted with the Discussion form?

The documentation and information is reviewed by the appropriate person at HDI and a determination is made to either uphold or overturn the overpayment. A letter is sent to the provider advising them of the determination. If HDI closes the finding after review of the Discussion information, HDI will work with the Medicare Claims Processing Contractor to close the AR or refund the monies if the offset has already occurred. The Discussion process does not impact the Medicare Claim Processing Contractor rebuttal or appeal process and does not stop recoupment.

How do I know that an account has been recouped?

The Medicare Claims Processing Contractor (“CPC”) will notify the provider via a Remittance Advice (“RA”) that it has established an Account Receivable (“AR”). The amount will be identified on the original RA as code N432. That is an indication that an AR has been set up and, if not paid back in 41 days, the CPC will recoup the amount with interest. After expiration of the forty one (41) day period, if payment is not made, the CPC will send a second RA in the amount that was recouped. We recommend that you retain the original RA for reference purposes.

Why can’t I access or login to my account on the HDI web portal?

For security purposes, providers and suppliers can only access HDI’s web portal using Internet Explorer 7.0, or higher, and Firefox 3.0, or higher. Internet Explorer 7.0 contains critical security updates not contained in earlier versions. If a provider has not upgraded to Internet Explorer 7, which was released in October, 2006, they will need to download the free software to access the web portal.

How will I know what issues the RAC is reviewing?

Once CMS approves an issue for review, HDI places the issue on the HDI website prior to any provider communications. Providers should regularly check the website for new issue updates.

Will HDI review only Medicare Fee for Service claims or will Medicare Advantage Claims also be reviewed?

RACs shall only review Medicare Fee for Service claims.

Why do I need to input my user name and password in the Provider Sign In area of the racinfo.com website to login?

CMS security requirements do not allow the storing of user names and passwords on the Provider Portal. You need to input your user name and password each time you login to the Provider Portal.

What states are included in HDI’s region?

Alaska, Arizona, California, South Dakota, North Dakota, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, Oregon, Utah, Washington and Wyoming

I know the RAC can review claims up to 3 years. Please explain how the 3 years period is determined.

Neither overpayments nor underpayments can be audited more than three (3) years past the initial claims paid date. • For complex reviews (where medical records are requested), the “look back” period is calculated by starting with the date the initial claim is paid and ends with the date the RAC issues the medical record request. Complex Review EXAMPLE: Claim date of service = 9/01-9/04/2007. Initial Claim payment date is = 10/4/2007. The RAC has up to 3 years from the initial claim paid date of 10/4/2007 to issue a medical record request (e.g., until 10/4/2010). If a medical request DATED on or before 10/4/2010 is received, it is within the “look back” period and the provider should promptly respond to the request. • For automated reviews, the “look back” period is calculated by starting with the initial claims paid date and ends with the date of the overpayment notification letter. Automated Review EXAMPLE: Claim date of service = 8/12/2007 Initial Claim payment date is = 1/18/2008 The RAC has up to 3 years from the initial claim paid date (1/18/2008) to issue a Demand Letter request (e.g., until 1/18/2011). If a Demand Letter DATED on or before 1/18/2011 is received, it is within the “look back” period and the provider should promptly respond to the request.

What is your Provider Relations toll-free number?

HDI’s contact numbers are as follows: Part A/Hospice: 866.590.5598 Part B/DME: 866.376.2319 Fax: Hospital & Hospice: 702.240.5595 Physician/DME: 702.240.5510

Why is the Knowledge Based Authentication (KBA) process used?

CMS has directed HealthDataInsights, Inc. (“HDI”) to allow providers to use a Knowledge Based Authentication method in order to securely access the HDI provider portal. The provider portal contains contact information for providers and enables providers to customize their contact information. It also contains the additional document request information as well as the receipt and review status of those records.

When does a provider need to use the Knowledge Based Authentication (KBA) to access the provider portal?

Part A Inpatient Hospitals (acute providers) were mailed a user name and password to access the HDI provider portal in 2009. If you already have a user name and password, it is not necessary to utilize the KBA method. Providers with a user name and password may sign in under “Provider Sign In”, located on the right side of the Login page. All other providers must initially utilize the Knowledge Based Authentication process to establish a password and gain access to the provider portal

What information can I access in the HDI Provider Portal?

After the login process, you have the ability to view and change contact information, view HDI requests for medical records and view the tracking of the medical records received.

How do I change/update provider contact information?

After the login process, you access the Account Management header and use the drop down box for Contact Information. Three columns of information appear. The first column is the Address from the Claims Processing Contractor (CPC) and can not be edited. The second column is the Contact to Receive Medical Record Request Letters. You may edit or delete contact information from this column. If you delete this information the contact will default to the CPC contact information. The third column is the Contact to Receive Improper Payment Letters. You may edit or delete contact information from this column as well. If you delete this information the contact will default to the CPC contact information. “Add Web Users” is found at the bottom of this page and allows up to a total of 7 Web Users. Please remember that any contact information in column 2 and/or column three is included in this total so if both columns are completed (even with the same information) you may only add 5 additional Web Users.

How do I track the status of the medical records I have sent to HDI?

After the login process, you access the Medical Record Tracking header. You are then directed to the Medical Record Tracking screen which provides the RAC Case ID, Medical Record Number, Date of Service From, Date of Service To, Documentation Requested (which indicates the date HDI requested the documentation), Documentation Received (which indicated the date HDI received the documentation), Review Results Letter Sent (which indicates the date the Review Results Letter was sent from HDI).

What is a Discussion period?

The Discussion period begins on the date set forth on the demand letter for automated reviews, or the date of the review results letter for complex reviews, and continues through the date the Claims Processing Contractor (“CPC”) recoups the amount (up to 41 days). The Discussion period offers Providers and Suppliers the opportunity to review the findings, and to provide HDI with additional information and/or documentation prior to recoupment by the CPC.

How do I open a Discussion with the RAC?

Before you can open a Discussion, you must have a demand letter (for automated reviews) or a review results letter (for complex reviews). Then, you obtain the Discussion form from the HDI provider portal at www.racinfo.healthdatainsights.com. The Discussion form is the first item after selecting the Provider Information tab. Fill in the information requested and submit any documentation and information that is pertinent to your case, to indicate why HDI should reconsider the finding. Fax the form and any documentation to HDI at (702) 240-5595 for Part A and (702) 240-5510 for Part B Discussions. If you do not have a demand letter or a review results letter, but have concerns or questions, please contact our customer service area at the appropriate number below: Part A Providers, including Hospital, SNF and Hospice Telephone: (866) 590-5598 Fax: (702) 240-5595 Part B and DME Providers Telephone: (866) 376-2319 Fax: (702) 240-5510

What happens to the documentation and information that is submitted with the Discussion form?

The documentation and information is reviewed by the appropriate person at HDI and a determination is made to either uphold or overturn the overpayment. A letter is sent to the provider advising them of the determination. If HDI closes the finding after review of the Discussion information, HDI will work with the Medicare Claims Processing Contractor to close the AR or refund the monies if the offset has already occurred. The Discussion process does not impact the Medicare Claim Processing Contractor rebuttal or appeal process and does not stop recoupment.

How do I know that an account has been recouped?

The Medicare Claims Processing Contractor (“CPC”) will notify the provider via a Remittance Advice (“RA”) that it has established an Account Receivable (“AR”). The amount will be identified on the original RA as code N432. That is an indication that an AR has been set up and, if not paid back in 41 days, the CPC will recoup the amount with interest. After expiration of the forty one (41) day period, if payment is not made, the CPC will send a second RA in the amount that was recouped. We recommend that you retain the original RA for reference purposes.

Why can’t I access or login to my account on the HDI web portal?

For security purposes, providers and suppliers can only access HDI’s web portal using Internet Explorer 7.0, or higher, and Firefox 3.0, or higher. Internet Explorer 7.0 contains critical security updates not contained in earlier versions. If a provider has not upgraded to Internet Explorer 7, which was released in October, 2006, they will need to download the free software to access the web portal.

How will I know what issues the RAC is reviewing?

Once CMS approves an issue for review, HDI places the issue on the HDI website prior to any provider communications. Providers should regularly check the website for new issue updates.

Will HDI review only Medicare Fee for Service claims or will Medicare Advantage Claims also be reviewed?

RACs shall only review Medicare Fee for Service claims.

Why do I need to input my user name and password in the Provider Sign In area of the racinfo.com website to login?

CMS security requirements do not allow the storing of user names and passwords on the Provider Portal. You need to input your user name and password each time you login to the Provider Portal.

What states are included in HDI’s region?

Alaska, Arizona, California, South Dakota, North Dakota, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, Oregon, Utah, Washington and Wyoming

I know the RAC can review claims up to 3 years. Please explain how the 3 years period is determined.

Neither overpayments nor underpayments can be audited more than three (3) years past the initial claims paid date. • For complex reviews (where medical records are requested), the “look back” period is calculated by starting with the date the initial claim is paid and ends with the date the RAC issues the medical record request. Complex Review EXAMPLE: Claim date of service = 9/01-9/04/2007. Initial Claim payment date is = 10/4/2007. The RAC has up to 3 years from the initial claim paid date of 10/4/2007 to issue a medical record request (e.g., until 10/4/2010). If a medical request DATED on or before 10/4/2010 is received, it is within the “look back” period and the provider should promptly respond to the request. • For automated reviews, the “look back” period is calculated by starting with the initial claims paid date and ends with the date of the overpayment notification letter. Automated Review EXAMPLE: Claim date of service = 8/12/2007 Initial Claim payment date is = 1/18/2008 The RAC has up to 3 years from the initial claim paid date (1/18/2008) to issue a Demand Letter request (e.g., until 1/18/2011). If a Demand Letter DATED on or before 1/18/2011 is received, it is within the “look back” period and the provider should promptly respond to the request.

What is your Provider Relations toll-free number?

HDI’s contact numbers are as follows: Part A/Hospice: 866.590.5598 Part B/DME: 866.376.2319 Fax: Hospital & Hospice: 702.240.5595 Physician/DME: 702.240.5510

Why is the Knowledge Based Authentication (KBA) process used?

CMS has directed HealthDataInsights, Inc. (“HDI”) to allow providers to use a Knowledge Based Authentication method in order to securely access the HDI provider portal. The provider portal contains contact information for providers and enables providers to customize their contact information. It also contains the additional document request information as well as the receipt and review status of those records.

When does a provider need to use the Knowledge Based Authentication (KBA) to access the provider portal?

Part A Inpatient Hospitals (acute providers) were mailed a user name and password to access the HDI provider portal in 2009. If you already have a user name and password, it is not necessary to utilize the KBA method. Providers with a user name and password may sign in under “Provider Sign In”, located on the right side of the Login page. All other providers must initially utilize the Knowledge Based Authentication process to establish a password and gain access to the provider portal

What information can I access in the HDI Provider Portal?

After the login process, you have the ability to view and change contact information, view HDI requests for medical records and view the tracking of the medical records received.

How do I change/update provider contact information?

After the login process, you access the Account Management header and use the drop down box for Contact Information. Three columns of information appear. The first column is the Address from the Claims Processing Contractor (CPC) and can not be edited. The second column is the Contact to Receive Medical Record Request Letters. You may edit or delete contact information from this column. If you delete this information the contact will default to the CPC contact information. The third column is the Contact to Receive Improper Payment Letters. You may edit or delete contact information from this column as well. If you delete this information the contact will default to the CPC contact information. “Add Web Users” is found at the bottom of this page and allows up to a total of 7 Web Users. Please remember that any contact information in column 2 and/or column three is included in this total so if both columns are completed (even with the same information) you may only add 5 additional Web Users.

How do I track the status of the medical records I have sent to HDI?

After the login process, you access the Medical Record Tracking header. You are then directed to the Medical Record Tracking screen which provides the RAC Case ID, Medical Record Number, Date of Service From, Date of Service To, Documentation Requested (which indicates the date HDI requested the documentation), Documentation Received (which indicated the date HDI received the documentation), Review Results Letter Sent (which indicates the date the Review Results Letter was sent from HDI).

What is a Discussion period?

The Discussion period begins on the date set forth on the demand letter for automated reviews, or the date of the review results letter for complex reviews, and continues through the date the Claims Processing Contractor (“CPC”) recoups the amount (up to 41 days). The Discussion period offers Providers and Suppliers the opportunity to review the findings, and to provide HDI with additional information and/or documentation prior to recoupment by the CPC.

How do I open a Discussion with the RAC?

Before you can open a Discussion, you must have a demand letter (for automated reviews) or a review results letter (for complex reviews). Then, you obtain the Discussion form from the HDI provider portal at www.racinfo.healthdatainsights.com. The Discussion form is the first item after selecting the Provider Information tab. Fill in the information requested and submit any documentation and information that is pertinent to your case, to indicate why HDI should reconsider the finding. Fax the form and any documentation to HDI at (702) 240-5595 for Part A and (702) 240-5510 for Part B Discussions. If you do not have a demand letter or a review results letter, but have concerns or questions, please contact our customer service area at the appropriate number below: Part A Providers, including Hospital, SNF and Hospice Telephone: (866) 590-5598 Fax: (702) 240-5595 Part B and DME Providers Telephone: (866) 376-2319 Fax: (702) 240-5510

What happens to the documentation and information that is submitted with the Discussion form?

The documentation and information is reviewed by the appropriate person at HDI and a determination is made to either uphold or overturn the overpayment. A letter is sent to the provider advising them of the determination. If HDI closes the finding after review of the Discussion information, HDI will work with the Medicare Claims Processing Contractor to close the AR or refund the monies if the offset has already occurred. The Discussion process does not impact the Medicare Claim Processing Contractor rebuttal or appeal process and does not stop recoupment.

How do I know that an account has been recouped?

The Medicare Claims Processing Contractor (“CPC”) will notify the provider via a Remittance Advice (“RA”) that it has established an Account Receivable (“AR”). The amount will be identified on the original RA as code N432. That is an indication that an AR has been set up and, if not paid back in 41 days, the CPC will recoup the amount with interest. After expiration of the forty one (41) day period, if payment is not made, the CPC will send a second RA in the amount that was recouped. We recommend that you retain the original RA for reference purposes.

Why can’t I access or login to my account on the HDI web portal?

For security purposes, providers and suppliers can only access HDI’s web portal using Internet Explorer 7.0, or higher, and Firefox 3.0, or higher. Internet Explorer 7.0 contains critical security updates not contained in earlier versions. If a provider has not upgraded to Internet Explorer 7, which was released in October, 2006, they will need to download the free software to access the web portal.

How will I know what issues the RAC is reviewing?

Once CMS approves an issue for review, HDI places the issue on the HDI website prior to any provider communications. Providers should regularly check the website for new issue updates.

Will HDI review only Medicare Fee for Service claims or will Medicare Advantage Claims also be reviewed?

RACs shall only review Medicare Fee for Service claims.

Why do I need to input my user name and password in the Provider Sign In area of the racinfo.com website to login?

CMS security requirements do not allow the storing of user names and passwords on the Provider Portal. You need to input your user name and password each time you login to the Provider Portal.

What states are included in HDI’s region?

Alaska, Arizona, California, South Dakota, North Dakota, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, Oregon, Utah, Washington and Wyoming

I know the RAC can review claims up to 3 years. Please explain how the 3 years period is determined.

Neither overpayments nor underpayments can be audited more than three (3) years past the initial claims paid date. • For complex reviews (where medical records are requested), the “look back” period is calculated by starting with the date the initial claim is paid and ends with the date the RAC issues the medical record request. Complex Review EXAMPLE: Claim date of service = 9/01-9/04/2007. Initial Claim payment date is = 10/4/2007. The RAC has up to 3 years from the initial claim paid date of 10/4/2007 to issue a medical record request (e.g., until 10/4/2010). If a medical request DATED on or before 10/4/2010 is received, it is within the “look back” period and the provider should promptly respond to the request. • For automated reviews, the “look back” period is calculated by starting with the initial claims paid date and ends with the date of the overpayment notification letter. Automated Review EXAMPLE: Claim date of service = 8/12/2007 Initial Claim payment date is = 1/18/2008 The RAC has up to 3 years from the initial claim paid date (1/18/2008) to issue a Demand Letter request (e.g., until 1/18/2011). If a Demand Letter DATED on or before 1/18/2011 is received, it is within the “look back” period and the provider should promptly respond to the request.

What is your Provider Relations toll-free number?

HDI’s contact numbers are as follows: Part A/Hospice: 866.590.5598 Part B/DME: 866.376.2319 Fax: Hospital & Hospice: 702.240.5595 Physician/DME: 702.240.5510

Why is the Knowledge Based Authentication (KBA) process used?

CMS has directed HealthDataInsights, Inc. (“HDI”) to allow providers to use a Knowledge Based Authentication method in order to securely access the HDI provider portal. The provider portal contains contact information for providers and enables providers to customize their contact information. It also contains the additional document request information as well as the receipt and review status of those records.

When does a provider need to use the Knowledge Based Authentication (KBA) to access the provider portal?

Part A Inpatient Hospitals (acute providers) were mailed a user name and password to access the HDI provider portal in 2009. If you already have a user name and password, it is not necessary to utilize the KBA method. Providers with a user name and password may sign in under “Provider Sign In”, located on the right side of the Login page. All other providers must initially utilize the Knowledge Based Authentication process to establish a password and gain access to the provider portal

What information can I access in the HDI Provider Portal?

After the login process, you have the ability to view and change contact information, view HDI requests for medical records and view the tracking of the medical records received.

How do I change/update provider contact information?

After the login process, you access the Account Management header and use the drop down box for Contact Information. Three columns of information appear. The first column is the Address from the Claims Processing Contractor (CPC) and can not be edited. The second column is the Contact to Receive Medical Record Request Letters. You may edit or delete contact information from this column. If you delete this information the contact will default to the CPC contact information. The third column is the Contact to Receive Improper Payment Letters. You may edit or delete contact information from this column as well. If you delete this information the contact will default to the CPC contact information. “Add Web Users” is found at the bottom of this page and allows up to a total of 7 Web Users. Please remember that any contact information in column 2 and/or column three is included in this total so if both columns are completed (even with the same information) you may only add 5 additional Web Users.

How do I track the status of the medical records I have sent to HDI?

After the login process, you access the Medical Record Tracking header. You are then directed to the Medical Record Tracking screen which provides the RAC Case ID, Medical Record Number, Date of Service From, Date of Service To, Documentation Requested (which indicates the date HDI requested the documentation), Documentation Received (which indicated the date HDI received the documentation), Review Results Letter Sent (which indicates the date the Review Results Letter was sent from HDI).

What is a Discussion period?

The Discussion period begins on the date set forth on the demand letter for automated reviews, or the date of the review results letter for complex reviews, and continues through the date the Claims Processing Contractor (“CPC”) recoups the amount (up to 41 days). The Discussion period offers Providers and Suppliers the opportunity to review the findings, and to provide HDI with additional information and/or documentation prior to recoupment by the CPC.

How do I open a Discussion with the RAC?

Before you can open a Discussion, you must have a demand letter (for automated reviews) or a review results letter (for complex reviews). Then, you obtain the Discussion form from the HDI provider portal at www.racinfo.healthdatainsights.com. The Discussion form is the first item after selecting the Provider Information tab. Fill in the information requested and submit any documentation and information that is pertinent to your case, to indicate why HDI should reconsider the finding. Fax the form and any documentation to HDI at (702) 240-5595 for Part A and (702) 240-5510 for Part B Discussions. If you do not have a demand letter or a review results letter, but have concerns or questions, please contact our customer service area at the appropriate number below: Part A Providers, including Hospital, SNF and Hospice Telephone: (866) 590-5598 Fax: (702) 240-5595 Part B and DME Providers Telephone: (866) 376-2319 Fax: (702) 240-5510

What happens to the documentation and information that is submitted with the Discussion form?

The documentation and information is reviewed by the appropriate person at HDI and a determination is made to either uphold or overturn the overpayment. A letter is sent to the provider advising them of the determination. If HDI closes the finding after review of the Discussion information, HDI will work with the Medicare Claims Processing Contractor to close the AR or refund the monies if the offset has already occurred. The Discussion process does not impact the Medicare Claim Processing Contractor rebuttal or appeal process and does not stop recoupment.

How do I know that an account has been recouped?

The Medicare Claims Processing Contractor (“CPC”) will notify the provider via a Remittance Advice (“RA”) that it has established an Account Receivable (“AR”). The amount will be identified on the original RA as code N432. That is an indication that an AR has been set up and, if not paid back in 41 days, the CPC will recoup the amount with interest. After expiration of the forty one (41) day period, if payment is not made, the CPC will send a second RA in the amount that was recouped. We recommend that you retain the original RA for reference purposes.

Why can’t I access or login to my account on the HDI web portal?

For security purposes, providers and suppliers can only access HDI’s web portal using Internet Explorer 7.0, or higher, and Firefox 3.0, or higher. Internet Explorer 7.0 contains critical security updates not contained in earlier versions. If a provider has not upgraded to Internet Explorer 7, which was released in October, 2006, they will need to download the free software to access the web portal.

How will I know what issues the RAC is reviewing?

Once CMS approves an issue for review, HDI places the issue on the HDI website prior to any provider communications. Providers should regularly check the website for new issue updates.

Will HDI review only Medicare Fee for Service claims or will Medicare Advantage Claims also be reviewed?

RACs shall only review Medicare Fee for Service claims.

Why do I need to input my user name and password in the Provider Sign In area of the racinfo.com website to login?

CMS security requirements do not allow the storing of user names and passwords on the Provider Portal. You need to input your user name and password each time you login to the Provider Portal.

What states are included in HDI’s region?

Alaska, Arizona, California, South Dakota, North Dakota, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, Oregon, Utah, Washington and Wyoming

I know the RAC can review claims up to 3 years. Please explain how the 3 years period is determined.

Neither overpayments nor underpayments can be audited more than three (3) years past the initial claims paid date. • For complex reviews (where medical records are requested), the “look back” period is calculated by starting with the date the initial claim is paid and ends with the date the RAC issues the medical record request. Complex Review EXAMPLE: Claim date of service = 9/01-9/04/2007. Initial Claim payment date is = 10/4/2007. The RAC has up to 3 years from the initial claim paid date of 10/4/2007 to issue a medical record request (e.g., until 10/4/2010). If a medical request DATED on or before 10/4/2010 is received, it is within the “look back” period and the provider should promptly respond to the request. • For automated reviews, the “look back” period is calculated by starting with the initial claims paid date and ends with the date of the overpayment notification letter. Automated Review EXAMPLE: Claim date of service = 8/12/2007 Initial Claim payment date is = 1/18/2008 The RAC has up to 3 years from the initial claim paid date (1/18/2008) to issue a Demand Letter request (e.g., until 1/18/2011). If a Demand Letter DATED on or before 1/18/2011 is received, it is within the “look back” period and the provider should promptly respond to the request.

What is your Provider Relations toll-free number?

HDI’s contact numbers are as follows: Part A/Hospice: 866.590.5598 Part B/DME: 866.376.2319 Fax: Hospital & Hospice: 702.240.5595 Physician/DME: 702.240.5510

Why is the Knowledge Based Authentication (KBA) process used?

CMS has directed HealthDataInsights, Inc. (“HDI”) to allow providers to use a Knowledge Based Authentication method in order to securely access the HDI provider portal. The provider portal contains contact information for providers and enables providers to customize their contact information. It also contains the additional document request information as well as the receipt and review status of those records.

When does a provider need to use the Knowledge Based Authentication (KBA) to access the provider portal?

Part A Inpatient Hospitals (acute providers) were mailed a user name and password to access the HDI provider portal in 2009. If you already have a user name and password, it is not necessary to utilize the KBA method. Providers with a user name and password may sign in under “Provider Sign In”, located on the right side of the Login page. All other providers must initially utilize the Knowledge Based Authentication process to establish a password and gain access to the provider portal

What information can I access in the HDI Provider Portal?

After the login process, you have the ability to view and change contact information, view HDI requests for medical records and view the tracking of the medical records received.

How do I change/update provider contact information?

After the login process, you access the Account Management header and use the drop down box for Contact Information. Three columns of information appear. The first column is the Address from the Claims Processing Contractor (CPC) and can not be edited. The second column is the Contact to Receive Medical Record Request Letters. You may edit or delete contact information from this column. If you delete this information the contact will default to the CPC contact information. The third column is the Contact to Receive Improper Payment Letters. You may edit or delete contact information from this column as well. If you delete this information the contact will default to the CPC contact information. “Add Web Users” is found at the bottom of this page and allows up to a total of 7 Web Users. Please remember that any contact information in column 2 and/or column three is included in this total so if both columns are completed (even with the same information) you may only add 5 additional Web Users.

How do I track the status of the medical records I have sent to HDI?

After the login process, you access the Medical Record Tracking header. You are then directed to the Medical Record Tracking screen which provides the RAC Case ID, Medical Record Number, Date of Service From, Date of Service To, Documentation Requested (which indicates the date HDI requested the documentation), Documentation Received (which indicated the date HDI received the documentation), Review Results Letter Sent (which indicates the date the Review Results Letter was sent from HDI).

What is a Discussion period?

The Discussion period begins on the date set forth on the demand letter for automated reviews, or the date of the review results letter for complex reviews, and continues through the date the Claims Processing Contractor (“CPC”) recoups the amount (up to 41 days). The Discussion period offers Providers and Suppliers the opportunity to review the findings, and to provide HDI with additional information and/or documentation prior to recoupment by the CPC.

How do I open a Discussion with the RAC?

Before you can open a Discussion, you must have a demand letter (for automated reviews) or a review results letter (for complex reviews). Then, you obtain the Discussion form from the HDI provider portal at www.racinfo.healthdatainsights.com. The Discussion form is the first item after selecting the Provider Information tab. Fill in the information requested and submit any documentation and information that is pertinent to your case, to indicate why HDI should reconsider the finding. Fax the form and any documentation to HDI at (702) 240-5595 for Part A and (702) 240-5510 for Part B Discussions. If you do not have a demand letter or a review results letter, but have concerns or questions, please contact our customer service area at the appropriate number below: Part A Providers, including Hospital, SNF and Hospice Telephone: (866) 590-5598 Fax: (702) 240-5595 Part B and DME Providers Telephone: (866) 376-2319 Fax: (702) 240-5510

What happens to the documentation and information that is submitted with the Discussion form?

The documentation and information is reviewed by the appropriate person at HDI and a determination is made to either uphold or overturn the overpayment. A letter is sent to the provider advising them of the determination. If HDI closes the finding after review of the Discussion information, HDI will work with the Medicare Claims Processing Contractor to close the AR or refund the monies if the offset has already occurred. The Discussion process does not impact the Medicare Claim Processing Contractor rebuttal or appeal process and does not stop recoupment.

How do I know that an account has been recouped?

The Medicare Claims Processing Contractor (“CPC”) will notify the provider via a Remittance Advice (“RA”) that it has established an Account Receivable (“AR”). The amount will be identified on the original RA as code N432. That is an indication that an AR has been set up and, if not paid back in 41 days, the CPC will recoup the amount with interest. After expiration of the forty one (41) day period, if payment is not made, the CPC will send a second RA in the amount that was recouped. We recommend that you retain the original RA for reference purposes.

Why can’t I access or login to my account on the HDI web portal?

For security purposes, providers and suppliers can only access HDI’s web portal using Internet Explorer 7.0, or higher, and Firefox 3.0, or higher. Internet Explorer 7.0 contains critical security updates not contained in earlier versions. If a provider has not upgraded to Internet Explorer 7, which was released in October, 2006, they will need to download the free software to access the web portal.

How will I know what issues the RAC is reviewing?

Once CMS approves an issue for review, HDI places the issue on the HDI website prior to any provider communications. Providers should regularly check the website for new issue updates.

Will HDI review only Medicare Fee for Service claims or will Medicare Advantage Claims also be reviewed?

RACs shall only review Medicare Fee for Service claims.

Why do I need to input my user name and password in the Provider Sign In area of the racinfo.com website to login?

CMS security requirements do not allow the storing of user names and passwords on the Provider Portal. You need to input your user name and password each time you login to the Provider Portal.

What states are included in HDI’s region?

Alaska, Arizona, California, South Dakota, North Dakota, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, Oregon, Utah, Washington and Wyoming

I know the RAC can review claims up to 3 years. Please explain how the 3 years period is determined.

Neither overpayments nor underpayments can be audited more than three (3) years past the initial claims paid date. • For complex reviews (where medical records are requested), the “look back” period is calculated by starting with the date the initial claim is paid and ends with the date the RAC issues the medical record request. Complex Review EXAMPLE: Claim date of service = 9/01-9/04/2007. Initial Claim payment date is = 10/4/2007. The RAC has up to 3 years from the initial claim paid date of 10/4/2007 to issue a medical record request (e.g., until 10/4/2010). If a medical request DATED on or before 10/4/2010 is received, it is within the “look back” period and the provider should promptly respond to the request. • For automated reviews, the “look back” period is calculated by starting with the initial claims paid date and ends with the date of the overpayment notification letter. Automated Review EXAMPLE: Claim date of service = 8/12/2007 Initial Claim payment date is = 1/18/2008 The RAC has up to 3 years from the initial claim paid date (1/18/2008) to issue a Demand Letter request (e.g., until 1/18/2011). If a Demand Letter DATED on or before 1/18/2011 is received, it is within the “look back” period and the provider should promptly respond to the request.

What is your Provider Relations toll-free number?

HDI’s contact numbers are as follows: Part A/Hospice: 866.590.5598 Part B/DME: 866.376.2319 Fax: Hospital & Hospice: 702.240.5595 Physician/DME: 702.240.5510

Why is the Knowledge Based Authentication (KBA) process used?

CMS has directed HealthDataInsights, Inc. (“HDI”) to allow providers to use a Knowledge Based Authentication method in order to securely access the HDI provider portal. The provider portal contains contact information for providers and enables providers to customize their contact information. It also contains the additional document request information as well as the receipt and review status of those records.

When does a provider need to use the Knowledge Based Authentication (KBA) to access the provider portal?

Part A Inpatient Hospitals (acute providers) were mailed a user name and password to access the HDI provider portal in 2009. If you already have a user name and password, it is not necessary to utilize the KBA method. Providers with a user name and password may sign in under “Provider Sign In”, located on the right side of the Login page. All other providers must initially utilize the Knowledge Based Authentication process to establish a password and gain access to the provider portal

What information can I access in the HDI Provider Portal?

After the login process, you have the ability to view and change contact information, view HDI requests for medical records and view the tracking of the medical records received.

How do I change/update provider contact information?

After the login process, you access the Account Management header and use the drop down box for Contact Information. Three columns of information appear. The first column is the Address from the Claims Processing Contractor (CPC) and can not be edited. The second column is the Contact to Receive Medical Record Request Letters. You may edit or delete contact information from this column. If you delete this information the contact will default to the CPC contact information. The third column is the Contact to Receive Improper Payment Letters. You may edit or delete contact information from this column as well. If you delete this information the contact will default to the CPC contact information. “Add Web Users” is found at the bottom of this page and allows up to a total of 7 Web Users. Please remember that any contact information in column 2 and/or column three is included in this total so if both columns are completed (even with the same information) you may only add 5 additional Web Users.

How do I track the status of the medical records I have sent to HDI?

After the login process, you access the Medical Record Tracking header. You are then directed to the Medical Record Tracking screen which provides the RAC Case ID, Medical Record Number, Date of Service From, Date of Service To, Documentation Requested (which indicates the date HDI requested the documentation), Documentation Received (which indicated the date HDI received the documentation), Review Results Letter Sent (which indicates the date the Review Results Letter was sent from HDI).

What is a Discussion period?

The Discussion period begins on the date set forth on the demand letter for automated reviews, or the date of the review results letter for complex reviews, and continues through the date the Claims Processing Contractor (“CPC”) recoups the amount (up to 41 days). The Discussion period offers Providers and Suppliers the opportunity to review the findings, and to provide HDI with additional information and/or documentation prior to recoupment by the CPC.

How do I open a Discussion with the RAC?

Before you can open a Discussion, you must have a demand letter (for automated reviews) or a review results letter (for complex reviews). Then, you obtain the Discussion form from the HDI provider portal at www.racinfo.healthdatainsights.com. The Discussion form is the first item after selecting the Provider Information tab. Fill in the information requested and submit any documentation and information that is pertinent to your case, to indicate why HDI should reconsider the finding. Fax the form and any documentation to HDI at (702) 240-5595 for Part A and (702) 240-5510 for Part B Discussions. If you do not have a demand letter or a review results letter, but have concerns or questions, please contact our customer service area at the appropriate number below: Part A Providers, including Hospital, SNF and Hospice Telephone: (866) 590-5598 Fax: (702) 240-5595 Part B and DME Providers Telephone: (866) 376-2319 Fax: (702) 240-5510

What happens to the documentation and information that is submitted with the Discussion form?

The documentation and information is reviewed by the appropriate person at HDI and a determination is made to either uphold or overturn the overpayment. A letter is sent to the provider advising them of the determination. If HDI closes the finding after review of the Discussion information, HDI will work with the Medicare Claims Processing Contractor to close the AR or refund the monies if the offset has already occurred. The Discussion process does not impact the Medicare Claim Processing Contractor rebuttal or appeal process and does not stop recoupment.

How do I know that an account has been recouped?

The Medicare Claims Processing Contractor (“CPC”) will notify the provider via a Remittance Advice (“RA”) that it has established an Account Receivable (“AR”). The amount will be identified on the original RA as code N432. That is an indication that an AR has been set up and, if not paid back in 41 days, the CPC will recoup the amount with interest. After expiration of the forty one (41) day period, if payment is not made, the CPC will send a second RA in the amount that was recouped. We recommend that you retain the original RA for reference purposes.

Why can’t I access or login to my account on the HDI web portal?

For security purposes, providers and suppliers can only access HDI’s web portal using Internet Explorer 7.0, or higher, and Firefox 3.0, or higher. Internet Explorer 7.0 contains critical security updates not contained in earlier versions. If a provider has not upgraded to Internet Explorer 7, which was released in October, 2006, they will need to download the free software to access the web portal.

How will I know what issues the RAC is reviewing?

Once CMS approves an issue for review, HDI places the issue on the HDI website prior to any provider communications. Providers should regularly check the website for new issue updates.

Will HDI review only Medicare Fee for Service claims or will Medicare Advantage Claims also be reviewed?

RACs shall only review Medicare Fee for Service claims.

Why do I need to input my user name and password in the Provider Sign In area of the racinfo.com website to login?

CMS security requirements do not allow the storing of user names and passwords on the Provider Portal. You need to input your user name and password each time you login to the Provider Portal.

What states are included in HDI’s region?

Alaska, Arizona, California, South Dakota, North Dakota, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, Oregon, Utah, Washington and Wyoming

I know the RAC can review claims up to 3 years. Please explain how the 3 years period is determined.

Neither overpayments nor underpayments can be audited more than three (3) years past the initial claims paid date. • For complex reviews (where medical records are requested), the “look back” period is calculated by starting with the date the initial claim is paid and ends with the date the RAC issues the medical record request. Complex Review EXAMPLE: Claim date of service = 9/01-9/04/2007. Initial Claim payment date is = 10/4/2007. The RAC has up to 3 years from the initial claim paid date of 10/4/2007 to issue a medical record request (e.g., until 10/4/2010). If a medical request DATED on or before 10/4/2010 is received, it is within the “look back” period and the provider should promptly respond to the request. • For automated reviews, the “look back” period is calculated by starting with the initial claims paid date and ends with the date of the overpayment notification letter. Automated Review EXAMPLE: Claim date of service = 8/12/2007 Initial Claim payment date is = 1/18/2008 The RAC has up to 3 years from the initial claim paid date (1/18/2008) to issue a Demand Letter request (e.g., until 1/18/2011). If a Demand Letter DATED on or before 1/18/2011 is received, it is within the “look back” period and the provider should promptly respond to the request.

What is your Provider Relations toll-free number?

HDI’s contact numbers are as follows: Part A/Hospice: 866.590.5598 Part B/DME: 866.376.2319 Fax: Hospital & Hospice: 702.240.5595 Physician/DME: 702.240.5510

Why is the Knowledge Based Authentication (KBA) process used?

CMS has directed HealthDataInsights, Inc. (“HDI”) to allow providers to use a Knowledge Based Authentication method in order to securely access the HDI provider portal. The provider portal contains contact information for providers and enables providers to customize their contact information. It also contains the additional document request information as well as the receipt and review status of those records.

When does a provider need to use the Knowledge Based Authentication (KBA) to access the provider portal?

Part A Inpatient Hospitals (acute providers) were mailed a user name and password to access the HDI provider portal in 2009. If you already have a user name and password, it is not necessary to utilize the KBA method. Providers with a user name and password may sign in under “Provider Sign In”, located on the right side of the Login page. All other providers must initially utilize the Knowledge Based Authentication process to establish a password and gain access to the provider portal

What information can I access in the HDI Provider Portal?

After the login process, you have the ability to view and change contact information, view HDI requests for medical records and view the tracking of the medical records received.

How do I change/update provider contact information?

After the login process, you access the Account Management header and use the drop down box for Contact Information. Three columns of information appear. The first column is the Address from the Claims Processing Contractor (CPC) and can not be edited. The second column is the Contact to Receive Medical Record Request Letters. You may edit or delete contact information from this column. If you delete this information the contact will default to the CPC contact information. The third column is the Contact to Receive Improper Payment Letters. You may edit or delete contact information from this column as well. If you delete this information the contact will default to the CPC contact information. “Add Web Users” is found at the bottom of this page and allows up to a total of 7 Web Users. Please remember that any contact information in column 2 and/or column three is included in this total so if both columns are completed (even with the same information) you may only add 5 additional Web Users.

How do I track the status of the medical records I have sent to HDI?

After the login process, you access the Medical Record Tracking header. You are then directed to the Medical Record Tracking screen which provides the RAC Case ID, Medical Record Number, Date of Service From, Date of Service To, Documentation Requested (which indicates the date HDI requested the documentation), Documentation Received (which indicated the date HDI received the documentation), Review Results Letter Sent (which indicates the date the Review Results Letter was sent from HDI).

What is a Discussion period?

The Discussion period begins on the date set forth on the demand letter for automated reviews, or the date of the review results letter for complex reviews, and continues through the date the Claims Processing Contractor (“CPC”) recoups the amount (up to 41 days). The Discussion period offers Providers and Suppliers the opportunity to review the findings, and to provide HDI with additional information and/or documentation prior to recoupment by the CPC.

How do I open a Discussion with the RAC?

Before you can open a Discussion, you must have a demand letter (for automated reviews) or a review results letter (for complex reviews). Then, you obtain the Discussion form from the HDI provider portal at www.racinfo.healthdatainsights.com. The Discussion form is the first item after selecting the Provider Information tab. Fill in the information requested and submit any documentation and information that is pertinent to your case, to indicate why HDI should reconsider the finding. Fax the form and any documentation to HDI at (702) 240-5595 for Part A and (702) 240-5510 for Part B Discussions. If you do not have a demand letter or a review results letter, but have concerns or questions, please contact our customer service area at the appropriate number below: Part A Providers, including Hospital, SNF and Hospice Telephone: (866) 590-5598 Fax: (702) 240-5595 Part B and DME Providers Telephone: (866) 376-2319 Fax: (702) 240-5510

What happens to the documentation and information that is submitted with the Discussion form?

The documentation and information is reviewed by the appropriate person at HDI and a determination is made to either uphold or overturn the overpayment. A letter is sent to the provider advising them of the determination. If HDI closes the finding after review of the Discussion information, HDI will work with the Medicare Claims Processing Contractor to close the AR or refund the monies if the offset has already occurred. The Discussion process does not impact the Medicare Claim Processing Contractor rebuttal or appeal process and does not stop recoupment.

How do I know that an account has been recouped?

The Medicare Claims Processing Contractor (“CPC”) will notify the provider via a Remittance Advice (“RA”) that it has established an Account Receivable (“AR”). The amount will be identified on the original RA as code N432. That is an indication that an AR has been set up and, if not paid back in 41 days, the CPC will recoup the amount with interest. After expiration of the forty one (41) day period, if payment is not made, the CPC will send a second RA in the amount that was recouped. We recommend that you retain the original RA for reference purposes.

Why can’t I access or login to my account on the HDI web portal?

For security purposes, providers and suppliers can only access HDI’s web portal using Internet Explorer 7.0, or higher, and Firefox 3.0, or higher. Internet Explorer 7.0 contains critical security updates not contained in earlier versions. If a provider has not upgraded to Internet Explorer 7, which was released in October, 2006, they will need to download the free software to access the web portal.

How will I know what issues the RAC is reviewing?

Once CMS approves an issue for review, HDI places the issue on the HDI website prior to any provider communications. Providers should regularly check the website for new issue updates.

Will HDI review only Medicare Fee for Service claims or will Medicare Advantage Claims also be reviewed?

RACs shall only review Medicare Fee for Service claims.

Why do I need to input my user name and password in the Provider Sign In area of the racinfo.com website to login?

CMS security requirements do not allow the storing of user names and passwords on the Provider Portal. You need to input your user name and password each time you login to the Provider Portal.

What states are included in HDI’s region?

Alaska, Arizona, California, South Dakota, North Dakota, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, Oregon, Utah, Washington and Wyoming

I know the RAC can review claims up to 3 years. Please explain how the 3 years period is determined.

Neither overpayments nor underpayments can be audited more than three (3) years past the initial claims paid date. • For complex reviews (where medical records are requested), the “look back” period is calculated by starting with the date the initial claim is paid and ends with the date the RAC issues the medical record request. Complex Review EXAMPLE: Claim date of service = 9/01-9/04/2007. Initial Claim payment date is = 10/4/2007. The RAC has up to 3 years from the initial claim paid date of 10/4/2007 to issue a medical record request (e.g., until 10/4/2010). If a medical request DATED on or before 10/4/2010 is received, it is within the “look back” period and the provider should promptly respond to the request. • For automated reviews, the “look back” period is calculated by starting with the initial claims paid date and ends with the date of the overpayment notification letter. Automated Review EXAMPLE: Claim date of service = 8/12/2007 Initial Claim payment date is = 1/18/2008 The RAC has up to 3 years from the initial claim paid date (1/18/2008) to issue a Demand Letter request (e.g., until 1/18/2011). If a Demand Letter DATED on or before 1/18/2011 is received, it is within the “look back” period and the provider should promptly respond to the request.

What is your Provider Relations toll-free number?

HDI’s contact numbers are as follows: Part A/Hospice: 866.590.5598 Part B/DME: 866.376.2319 Fax: Hospital & Hospice: 702.240.5595 Physician/DME: 702.240.5510

Why is the Knowledge Based Authentication (KBA) process used?

CMS has directed HealthDataInsights, Inc. (“HDI”) to allow providers to use a Knowledge Based Authentication method in order to securely access the HDI provider portal. The provider portal contains contact information for providers and enables providers to customize their contact information. It also contains the additional document request information as well as the receipt and review status of those records.

When does a provider need to use the Knowledge Based Authentication (KBA) to access the provider portal?

Part A Inpatient Hospitals (acute providers) were mailed a user name and password to access the HDI provider portal in 2009. If you already have a user name and password, it is not necessary to utilize the KBA method. Providers with a user name and password may sign in under “Provider Sign In”, located on the right side of the Login page. All other providers must initially utilize the Knowledge Based Authentication process to establish a password and gain access to the provider portal

What information can I access in the HDI Provider Portal?

After the login process, you have the ability to view and change contact information, view HDI requests for medical records and view the tracking of the medical records received.

How do I change/update provider contact information?

After the login process, you access the Account Management header and use the drop down box for Contact Information. Three columns of information appear. The first column is the Address from the Claims Processing Contractor (CPC) and can not be edited. The second column is the Contact to Receive Medical Record Request Letters. You may edit or delete contact information from this column. If you delete this information the contact will default to the CPC contact information. The third column is the Contact to Receive Improper Payment Letters. You may edit or delete contact information from this column as well. If you delete this information the contact will default to the CPC contact information. “Add Web Users” is found at the bottom of this page and allows up to a total of 7 Web Users. Please remember that any contact information in column 2 and/or column three is included in this total so if both columns are completed (even with the same information) you may only add 5 additional Web Users.

How do I track the status of the medical records I have sent to HDI?

After the login process, you access the Medical Record Tracking header. You are then directed to the Medical Record Tracking screen which provides the RAC Case ID, Medical Record Number, Date of Service From, Date of Service To, Documentation Requested (which indicates the date HDI requested the documentation), Documentation Received (which indicated the date HDI received the documentation), Review Results Letter Sent (which indicates the date the Review Results Letter was sent from HDI).

What is a Discussion period?

The Discussion period begins on the date set forth on the demand letter for automated reviews, or the date of the review results letter for complex reviews, and continues through the date the Claims Processing Contractor (“CPC”) recoups the amount (up to 41 days). The Discussion period offers Providers and Suppliers the opportunity to review the findings, and to provide HDI with additional information and/or documentation prior to recoupment by the CPC.

How do I open a Discussion with the RAC?

Before you can open a Discussion, you must have a demand letter (for automated reviews) or a review results letter (for complex reviews). Then, you obtain the Discussion form from the HDI provider portal at www.racinfo.healthdatainsights.com. The Discussion form is the first item after selecting the Provider Information tab. Fill in the information requested and submit any documentation and information that is pertinent to your case, to indicate why HDI should reconsider the finding. Fax the form and any documentation to HDI at (702) 240-5595 for Part A and (702) 240-5510 for Part B Discussions. If you do not have a demand letter or a review results letter, but have concerns or questions, please contact our customer service area at the appropriate number below: Part A Providers, including Hospital, SNF and Hospice Telephone: (866) 590-5598 Fax: (702) 240-5595 Part B and DME Providers Telephone: (866) 376-2319 Fax: (702) 240-5510

What happens to the documentation and information that is submitted with the Discussion form?

The documentation and information is reviewed by the appropriate person at HDI and a determination is made to either uphold or overturn the overpayment. A letter is sent to the provider advising them of the determination. If HDI closes the finding after review of the Discussion information, HDI will work with the Medicare Claims Processing Contractor to close the AR or refund the monies if the offset has already occurred. The Discussion process does not impact the Medicare Claim Processing Contractor rebuttal or appeal process and does not stop recoupment.

How do I know that an account has been recouped?

The Medicare Claims Processing Contractor (“CPC”) will notify the provider via a Remittance Advice (“RA”) that it has established an Account Receivable (“AR”). The amount will be identified on the original RA as code N432. That is an indication that an AR has been set up and, if not paid back in 41 days, the CPC will recoup the amount with interest. After expiration of the forty one (41) day period, if payment is not made, the CPC will send a second RA in the amount that was recouped. We recommend that you retain the original RA for reference purposes.

Why can’t I access or login to my account on the HDI web portal?

For security purposes, providers and suppliers can only access HDI’s web portal using Internet Explorer 7.0, or higher, and Firefox 3.0, or higher. Internet Explorer 7.0 contains critical security updates not contained in earlier versions. If a provider has not upgraded to Internet Explorer 7, which was released in October, 2006, they will need to download the free software to access the web portal.

How will I know what issues the RAC is reviewing?

Once CMS approves an issue for review, HDI places the issue on the HDI website prior to any provider communications. Providers should regularly check the website for new issue updates.

Will HDI review only Medicare Fee for Service claims or will Medicare Advantage Claims also be reviewed?

RACs shall only review Medicare Fee for Service claims.

Why do I need to input my user name and password in the Provider Sign In area of the racinfo.com website to login?

CMS security requirements do not allow the storing of user names and passwords on the Provider Portal. You need to input your user name and password each time you login to the Provider Portal.

What states are included in HDI’s region?

Alaska, Arizona, California, South Dakota, North Dakota, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, Oregon, Utah, Washington and Wyoming

I know the RAC can review claims up to 3 years. Please explain how the 3 years period is determined.

Neither overpayments nor underpayments can be audited more than three (3) years past the initial claims paid date. • For complex reviews (where medical records are requested), the “look back” period is calculated by starting with the date the initial claim is paid and ends with the date the RAC issues the medical record request. Complex Review EXAMPLE: Claim date of service = 9/01-9/04/2007. Initial Claim payment date is = 10/4/2007. The RAC has up to 3 years from the initial claim paid date of 10/4/2007 to issue a medical record request (e.g., until 10/4/2010). If a medical request DATED on or before 10/4/2010 is received, it is within the “look back” period and the provider should promptly respond to the request. • For automated reviews, the “look back” period is calculated by starting with the initial claims paid date and ends with the date of the overpayment notification letter. Automated Review EXAMPLE: Claim date of service = 8/12/2007 Initial Claim payment date is = 1/18/2008 The RAC has up to 3 years from the initial claim paid date (1/18/2008) to issue a Demand Letter request (e.g., until 1/18/2011). If a Demand Letter DATED on or before 1/18/2011 is received, it is within the “look back” period and the provider should promptly respond to the request.

What is your Provider Relations toll-free number?

HDI’s contact numbers are as follows: Part A/Hospice: 866.590.5598 Part B/DME: 866.376.2319 Fax: Hospital & Hospice: 702.240.5595 Physician/DME: 702.240.5510

Why is the Knowledge Based Authentication (KBA) process used?

CMS has directed HealthDataInsights, Inc. (“HDI”) to allow providers to use a Knowledge Based Authentication method in order to securely access the HDI provider portal. The provider portal contains contact information for providers and enables providers to customize their contact information. It also contains the additional document request information as well as the receipt and review status of those records.

When does a provider need to use the Knowledge Based Authentication (KBA) to access the provider portal?

Part A Inpatient Hospitals (acute providers) were mailed a user name and password to access the HDI provider portal in 2009. If you already have a user name and password, it is not necessary to utilize the KBA method. Providers with a user name and password may sign in under “Provider Sign In”, located on the right side of the Login page. All other providers must initially utilize the Knowledge Based Authentication process to establish a password and gain access to the provider portal

What information can I access in the HDI Provider Portal?

After the login process, you have the ability to view and change contact information, view HDI requests for medical records and view the tracking of the medical records received.

How do I change/update provider contact information?

After the login process, you access the Account Management header and use the drop down box for Contact Information. Three columns of information appear. The first column is the Address from the Claims Processing Contractor (CPC) and can not be edited. The second column is the Contact to Receive Medical Record Request Letters. You may edit or delete contact information from this column. If you delete this information the contact will default to the CPC contact information. The third column is the Contact to Receive Improper Payment Letters. You may edit or delete contact information from this column as well. If you delete this information the contact will default to the CPC contact information. “Add Web Users” is found at the bottom of this page and allows up to a total of 7 Web Users. Please remember that any contact information in column 2 and/or column three is included in this total so if both columns are completed (even with the same information) you may only add 5 additional Web Users.

How do I track the status of the medical records I have sent to HDI?

After the login process, you access the Medical Record Tracking header. You are then directed to the Medical Record Tracking screen which provides the RAC Case ID, Medical Record Number, Date of Service From, Date of Service To, Documentation Requested (which indicates the date HDI requested the documentation), Documentation Received (which indicated the date HDI received the documentation), Review Results Letter Sent (which indicates the date the Review Results Letter was sent from HDI).

What is a Discussion period?

The Discussion period begins on the date set forth on the demand letter for automated reviews, or the date of the review results letter for complex reviews, and continues through the date the Claims Processing Contractor (“CPC”) recoups the amount (up to 41 days). The Discussion period offers Providers and Suppliers the opportunity to review the findings, and to provide HDI with additional information and/or documentation prior to recoupment by the CPC.

How do I open a Discussion with the RAC?

Before you can open a Discussion, you must have a demand letter (for automated reviews) or a review results letter (for complex reviews). Then, you obtain the Discussion form from the HDI provider portal at www.racinfo.healthdatainsights.com. The Discussion form is the first item after selecting the Provider Information tab. Fill in the information requested and submit any documentation and information that is pertinent to your case, to indicate why HDI should reconsider the finding. Fax the form and any documentation to HDI at (702) 240-5595 for Part A and (702) 240-5510 for Part B Discussions. If you do not have a demand letter or a review results letter, but have concerns or questions, please contact our customer service area at the appropriate number below: Part A Providers, including Hospital, SNF and Hospice Telephone: (866) 590-5598 Fax: (702) 240-5595 Part B and DME Providers Telephone: (866) 376-2319 Fax: (702) 240-5510

What happens to the documentation and information that is submitted with the Discussion form?

The documentation and information is reviewed by the appropriate person at HDI and a determination is made to either uphold or overturn the overpayment. A letter is sent to the provider advising them of the determination. If HDI closes the finding after review of the Discussion information, HDI will work with the Medicare Claims Processing Contractor to close the AR or refund the monies if the offset has already occurred. The Discussion process does not impact the Medicare Claim Processing Contractor rebuttal or appeal process and does not stop recoupment.

How do I know that an account has been recouped?

The Medicare Claims Processing Contractor (“CPC”) will notify the provider via a Remittance Advice (“RA”) that it has established an Account Receivable (“AR”). The amount will be identified on the original RA as code N432. That is an indication that an AR has been set up and, if not paid back in 41 days, the CPC will recoup the amount with interest. After expiration of the forty one (41) day period, if payment is not made, the CPC will send a second RA in the amount that was recouped. We recommend that you retain the original RA for reference purposes.

Why can’t I access or login to my account on the HDI web portal?

For security purposes, providers and suppliers can only access HDI’s web portal using Internet Explorer 7.0, or higher, and Firefox 3.0, or higher. Internet Explorer 7.0 contains critical security updates not contained in earlier versions. If a provider has not upgraded to Internet Explorer 7, which was released in October, 2006, they will need to download the free software to access the web portal.

How will I know what issues the RAC is reviewing?

Once CMS approves an issue for review, HDI places the issue on the HDI website prior to any provider communications. Providers should regularly check the website for new issue updates.

Will HDI review only Medicare Fee for Service claims or will Medicare Advantage Claims also be reviewed?

RACs shall only review Medicare Fee for Service claims.

Why do I need to input my user name and password in the Provider Sign In area of the racinfo.com website to login?

CMS security requirements do not allow the storing of user names and passwords on the Provider Portal. You need to input your user name and password each time you login to the Provider Portal.

What states are included in HDI’s region?

Alaska, Arizona, California, South Dakota, North Dakota, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, Oregon, Utah, Washington and Wyoming

I know the RAC can review claims up to 3 years. Please explain how the 3 years period is determined.

Neither overpayments nor underpayments can be audited more than three (3) years past the initial claims paid date. • For complex reviews (where medical records are requested), the “look back” period is calculated by starting with the date the initial claim is paid and ends with the date the RAC issues the medical record request. Complex Review EXAMPLE: Claim date of service = 9/01-9/04/2007. Initial Claim payment date is = 10/4/2007. The RAC has up to 3 years from the initial claim paid date of 10/4/2007 to issue a medical record request (e.g., until 10/4/2010). If a medical request DATED on or before 10/4/2010 is received, it is within the “look back” period and the provider should promptly respond to the request. • For automated reviews, the “look back” period is calculated by starting with the initial claims paid date and ends with the date of the overpayment notification letter. Automated Review EXAMPLE: Claim date of service = 8/12/2007 Initial Claim payment date is = 1/18/2008 The RAC has up to 3 years from the initial claim paid date (1/18/2008) to issue a Demand Letter request (e.g., until 1/18/2011). If a Demand Letter DATED on or before 1/18/2011 is received, it is within the “look back” period and the provider should promptly respond to the request.

What is your Provider Relations toll-free number?

HDI’s contact numbers are as follows: Part A/Hospice: 866.590.5598 Part B/DME: 866.376.2319 Fax: Hospital & Hospice: 702.240.5595 Physician/DME: 702.240.5510

Why is the Knowledge Based Authentication (KBA) process used?

CMS has directed HealthDataInsights, Inc. (“HDI”) to allow providers to use a Knowledge Based Authentication method in order to securely access the HDI provider portal. The provider portal contains contact information for providers and enables providers to customize their contact information. It also contains the additional document request information as well as the receipt and review status of those records.

When does a provider need to use the Knowledge Based Authentication (KBA) to access the provider portal?

Part A Inpatient Hospitals (acute providers) were mailed a user name and password to access the HDI provider portal in 2009. If you already have a user name and password, it is not necessary to utilize the KBA method. Providers with a user name and password may sign in under “Provider Sign In”, located on the right side of the Login page. All other providers must initially utilize the Knowledge Based Authentication process to establish a password and gain access to the provider portal

What information can I access in the HDI Provider Portal?

After the login process, you have the ability to view and change contact information, view HDI requests for medical records and view the tracking of the medical records received.

How do I change/update provider contact information?

After the login process, you access the Account Management header and use the drop down box for Contact Information. Three columns of information appear. The first column is the Address from the Claims Processing Contractor (CPC) and can not be edited. The second column is the Contact to Receive Medical Record Request Letters. You may edit or delete contact information from this column. If you delete this information the contact will default to the CPC contact information. The third column is the Contact to Receive Improper Payment Letters. You may edit or delete contact information from this column as well. If you delete this information the contact will default to the CPC contact information. “Add Web Users” is found at the bottom of this page and allows up to a total of 7 Web Users. Please remember that any contact information in column 2 and/or column three is included in this total so if both columns are completed (even with the same information) you may only add 5 additional Web Users.

How do I track the status of the medical records I have sent to HDI?

After the login process, you access the Medical Record Tracking header. You are then directed to the Medical Record Tracking screen which provides the RAC Case ID, Medical Record Number, Date of Service From, Date of Service To, Documentation Requested (which indicates the date HDI requested the documentation), Documentation Received (which indicated the date HDI received the documentation), Review Results Letter Sent (which indicates the date the Review Results Letter was sent from HDI).

What is a Discussion period?

The Discussion period begins on the date set forth on the demand letter for automated reviews, or the date of the review results letter for complex reviews, and continues through the date the Claims Processing Contractor (“CPC”) recoups the amount (up to 41 days). The Discussion period offers Providers and Suppliers the opportunity to review the findings, and to provide HDI with additional information and/or documentation prior to recoupment by the CPC.

How do I open a Discussion with the RAC?

Before you can open a Discussion, you must have a demand letter (for automated reviews) or a review results letter (for complex reviews). Then, you obtain the Discussion form from the HDI provider portal at www.racinfo.healthdatainsights.com. The Discussion form is the first item after selecting the Provider Information tab. Fill in the information requested and submit any documentation and information that is pertinent to your case, to indicate why HDI should reconsider the finding. Fax the form and any documentation to HDI at (702) 240-5595 for Part A and (702) 240-5510 for Part B Discussions. If you do not have a demand letter or a review results letter, but have concerns or questions, please contact our customer service area at the appropriate number below: Part A Providers, including Hospital, SNF and Hospice Telephone: (866) 590-5598 Fax: (702) 240-5595 Part B and DME Providers Telephone: (866) 376-2319 Fax: (702) 240-5510

What happens to the documentation and information that is submitted with the Discussion form?

The documentation and information is reviewed by the appropriate person at HDI and a determination is made to either uphold or overturn the overpayment. A letter is sent to the provider advising them of the determination. If HDI closes the finding after review of the Discussion information, HDI will work with the Medicare Claims Processing Contractor to close the AR or refund the monies if the offset has already occurred. The Discussion process does not impact the Medicare Claim Processing Contractor rebuttal or appeal process and does not stop recoupment.

How do I know that an account has been recouped?

The Medicare Claims Processing Contractor (“CPC”) will notify the provider via a Remittance Advice (“RA”) that it has established an Account Receivable (“AR”). The amount will be identified on the original RA as code N432. That is an indication that an AR has been set up and, if not paid back in 41 days, the CPC will recoup the amount with interest. After expiration of the forty one (41) day period, if payment is not made, the CPC will send a second RA in the amount that was recouped. We recommend that you retain the original RA for reference purposes.

Why can’t I access or login to my account on the HDI web portal?

For security purposes, providers and suppliers can only access HDI’s web portal using Internet Explorer 7.0, or higher, and Firefox 3.0, or higher. Internet Explorer 7.0 contains critical security updates not contained in earlier versions. If a provider has not upgraded to Internet Explorer 7, which was released in October, 2006, they will need to download the free software to access the web portal.

How will I know what issues the RAC is reviewing?

Once CMS approves an issue for review, HDI places the issue on the HDI website prior to any provider communications. Providers should regularly check the website for new issue updates.

Will HDI review only Medicare Fee for Service claims or will Medicare Advantage Claims also be reviewed?

RACs shall only review Medicare Fee for Service claims.

Why do I need to input my user name and password in the Provider Sign In area of the racinfo.com website to login?

CMS security requirements do not allow the storing of user names and passwords on the Provider Portal. You need to input your user name and password each time you login to the Provider Portal.

What states are included in HDI’s region?

Alaska, Arizona, California, South Dakota, North Dakota, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, Oregon, Utah, Washington and Wyoming

I know the RAC can review claims up to 3 years. Please explain how the 3 years period is determined.

Neither overpayments nor underpayments can be audited more than three (3) years past the initial claims paid date. • For complex reviews (where medical records are requested), the “look back” period is calculated by starting with the date the initial claim is paid and ends with the date the RAC issues the medical record request. Complex Review EXAMPLE: Claim date of service = 9/01-9/04/2007. Initial Claim payment date is = 10/4/2007. The RAC has up to 3 years from the initial claim paid date of 10/4/2007 to issue a medical record request (e.g., until 10/4/2010). If a medical request DATED on or before 10/4/2010 is received, it is within the “look back” period and the provider should promptly respond to the request. • For automated reviews, the “look back” period is calculated by starting with the initial claims paid date and ends with the date of the overpayment notification letter. Automated Review EXAMPLE: Claim date of service = 8/12/2007 Initial Claim payment date is = 1/18/2008 The RAC has up to 3 years from the initial claim paid date (1/18/2008) to issue a Demand Letter request (e.g., until 1/18/2011). If a Demand Letter DATED on or before 1/18/2011 is received, it is within the “look back” period and the provider should promptly respond to the request.

What is your Provider Relations toll-free number?

HDI’s contact numbers are as follows: Part A/Hospice: 866.590.5598 Part B/DME: 866.376.2319 Fax: Hospital & Hospice: 702.240.5595 Physician/DME: 702.240.5510

Why is the Knowledge Based Authentication (KBA) process used?

CMS has directed HealthDataInsights, Inc. (“HDI”) to allow providers to use a Knowledge Based Authentication method in order to securely access the HDI provider portal. The provider portal contains contact information for providers and enables providers to customize their contact information. It also contains the additional document request information as well as the receipt and review status of those records.

When does a provider need to use the Knowledge Based Authentication (KBA) to access the provider portal?

Part A Inpatient Hospitals (acute providers) were mailed a user name and password to access the HDI provider portal in 2009. If you already have a user name and password, it is not necessary to utilize the KBA method. Providers with a user name and password may sign in under “Provider Sign In”, located on the right side of the Login page. All other providers must initially utilize the Knowledge Based Authentication process to establish a password and gain access to the provider portal

What information can I access in the HDI Provider Portal?

After the login process, you have the ability to view and change contact information, view HDI requests for medical records and view the tracking of the medical records received.

How do I change/update provider contact information?

After the login process, you access the Account Management header and use the drop down box for Contact Information. Three columns of information appear. The first column is the Address from the Claims Processing Contractor (CPC) and can not be edited. The second column is the Contact to Receive Medical Record Request Letters. You may edit or delete contact information from this column. If you delete this information the contact will default to the CPC contact information. The third column is the Contact to Receive Improper Payment Letters. You may edit or delete contact information from this column as well. If you delete this information the contact will default to the CPC contact information. “Add Web Users” is found at the bottom of this page and allows up to a total of 7 Web Users. Please remember that any contact information in column 2 and/or column three is included in this total so if both columns are completed (even with the same information) you may only add 5 additional Web Users.

How do I track the status of the medical records I have sent to HDI?

After the login process, you access the Medical Record Tracking header. You are then directed to the Medical Record Tracking screen which provides the RAC Case ID, Medical Record Number, Date of Service From, Date of Service To, Documentation Requested (which indicates the date HDI requested the documentation), Documentation Received (which indicated the date HDI received the documentation), Review Results Letter Sent (which indicates the date the Review Results Letter was sent from HDI).

What is a Discussion period?

The Discussion period begins on the date set forth on the demand letter for automated reviews, or the date of the review results letter for complex reviews, and continues through the date the Claims Processing Contractor (“CPC”) recoups the amount (up to 41 days). The Discussion period offers Providers and Suppliers the opportunity to review the findings, and to provide HDI with additional information and/or documentation prior to recoupment by the CPC.

How do I open a Discussion with the RAC?

Before you can open a Discussion, you must have a demand letter (for automated reviews) or a review results letter (for complex reviews). Then, you obtain the Discussion form from the HDI provider portal at www.racinfo.healthdatainsights.com. The Discussion form is the first item after selecting the Provider Information tab. Fill in the information requested and submit any documentation and information that is pertinent to your case, to indicate why HDI should reconsider the finding. Fax the form and any documentation to HDI at (702) 240-5595 for Part A and (702) 240-5510 for Part B Discussions. If you do not have a demand letter or a review results letter, but have concerns or questions, please contact our customer service area at the appropriate number below: Part A Providers, including Hospital, SNF and Hospice Telephone: (866) 590-5598 Fax: (702) 240-5595 Part B and DME Providers Telephone: (866) 376-2319 Fax: (702) 240-5510

What happens to the documentation and information that is submitted with the Discussion form?

The documentation and information is reviewed by the appropriate person at HDI and a determination is made to either uphold or overturn the overpayment. A letter is sent to the provider advising them of the determination. If HDI closes the finding after review of the Discussion information, HDI will work with the Medicare Claims Processing Contractor to close the AR or refund the monies if the offset has already occurred. The Discussion process does not impact the Medicare Claim Processing Contractor rebuttal or appeal process and does not stop recoupment.

How do I know that an account has been recouped?

The Medicare Claims Processing Contractor (“CPC”) will notify the provider via a Remittance Advice (“RA”) that it has established an Account Receivable (“AR”). The amount will be identified on the original RA as code N432. That is an indication that an AR has been set up and, if not paid back in 41 days, the CPC will recoup the amount with interest. After expiration of the forty one (41) day period, if payment is not made, the CPC will send a second RA in the amount that was recouped. We recommend that you retain the original RA for reference purposes.

Why can’t I access or login to my account on the HDI web portal?

For security purposes, providers and suppliers can only access HDI’s web portal using Internet Explorer 7.0, or higher, and Firefox 3.0, or higher. Internet Explorer 7.0 contains critical security updates not contained in earlier versions. If a provider has not upgraded to Internet Explorer 7, which was released in October, 2006, they will need to download the free software to access the web portal.

How will I know what issues the RAC is reviewing?

Once CMS approves an issue for review, HDI places the issue on the HDI website prior to any provider communications. Providers should regularly check the website for new issue updates.

Will HDI review only Medicare Fee for Service claims or will Medicare Advantage Claims also be reviewed?

RACs shall only review Medicare Fee for Service claims.

Why do I need to input my user name and password in the Provider Sign In area of the racinfo.com website to login?

CMS security requirements do not allow the storing of user names and passwords on the Provider Portal. You need to input your user name and password each time you login to the Provider Portal.

What states are included in HDI’s region?

Alaska, Arizona, California, South Dakota, North Dakota, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, Oregon, Utah, Washington and Wyoming

I know the RAC can review claims up to 3 years. Please explain how the 3 years period is determined.

Neither overpayments nor underpayments can be audited more than three (3) years past the initial claims paid date. • For complex reviews (where medical records are requested), the “look back” period is calculated by starting with the date the initial claim is paid and ends with the date the RAC issues the medical record request. Complex Review EXAMPLE: Claim date of service = 9/01-9/04/2007. Initial Claim payment date is = 10/4/2007. The RAC has up to 3 years from the initial claim paid date of 10/4/2007 to issue a medical record request (e.g., until 10/4/2010). If a medical request DATED on or before 10/4/2010 is received, it is within the “look back” period and the provider should promptly respond to the request. • For automated reviews, the “look back” period is calculated by starting with the initial claims paid date and ends with the date of the overpayment notification letter. Automated Review EXAMPLE: Claim date of service = 8/12/2007 Initial Claim payment date is = 1/18/2008 The RAC has up to 3 years from the initial claim paid date (1/18/2008) to issue a Demand Letter request (e.g., until 1/18/2011). If a Demand Letter DATED on or before 1/18/2011 is received, it is within the “look back” period and the provider should promptly respond to the request.

What is your Provider Relations toll-free number?

HDI’s contact numbers are as follows: Part A/Hospice: 866.590.5598 Part B/DME: 866.376.2319 Fax: Hospital & Hospice: 702.240.5595 Physician/DME: 702.240.5510

Why is the Knowledge Based Authentication (KBA) process used?

CMS has directed HealthDataInsights, Inc. (“HDI”) to allow providers to use a Knowledge Based Authentication method in order to securely access the HDI provider portal. The provider portal contains contact information for providers and enables providers to customize their contact information. It also contains the additional document request information as well as the receipt and review status of those records.

When does a provider need to use the Knowledge Based Authentication (KBA) to access the provider portal?

Part A Inpatient Hospitals (acute providers) were mailed a user name and password to access the HDI provider portal in 2009. If you already have a user name and password, it is not necessary to utilize the KBA method. Providers with a user name and password may sign in under “Provider Sign In”, located on the right side of the Login page. All other providers must initially utilize the Knowledge Based Authentication process to establish a password and gain access to the provider portal

What information can I access in the HDI Provider Portal?

After the login process, you have the ability to view and change contact information, view HDI requests for medical records and view the tracking of the medical records received.

How do I change/update provider contact information?

After the login process, you access the Account Management header and use the drop down box for Contact Information. Three columns of information appear. The first column is the Address from the Claims Processing Contractor (CPC) and can not be edited. The second column is the Contact to Receive Medical Record Request Letters. You may edit or delete contact information from this column. If you delete this information the contact will default to the CPC contact information. The third column is the Contact to Receive Improper Payment Letters. You may edit or delete contact information from this column as well. If you delete this information the contact will default to the CPC contact information. “Add Web Users” is found at the bottom of this page and allows up to a total of 7 Web Users. Please remember that any contact information in column 2 and/or column three is included in this total so if both columns are completed (even with the same information) you may only add 5 additional Web Users.

How do I track the status of the medical records I have sent to HDI?

After the login process, you access the Medical Record Tracking header. You are then directed to the Medical Record Tracking screen which provides the RAC Case ID, Medical Record Number, Date of Service From, Date of Service To, Documentation Requested (which indicates the date HDI requested the documentation), Documentation Received (which indicated the date HDI received the documentation), Review Results Letter Sent (which indicates the date the Review Results Letter was sent from HDI).

What is a Discussion period?

The Discussion period begins on the date set forth on the demand letter for automated reviews, or the date of the review results letter for complex reviews, and continues through the date the Claims Processing Contractor (“CPC”) recoups the amount (up to 41 days). The Discussion period offers Providers and Suppliers the opportunity to review the findings, and to provide HDI with additional information and/or documentation prior to recoupment by the CPC.

How do I open a Discussion with the RAC?

Before you can open a Discussion, you must have a demand letter (for automated reviews) or a review results letter (for complex reviews). Then, you obtain the Discussion form from the HDI provider portal at www.racinfo.healthdatainsights.com. The Discussion form is the first item after selecting the Provider Information tab. Fill in the information requested and submit any documentation and information that is pertinent to your case, to indicate why HDI should reconsider the finding. Fax the form and any documentation to HDI at (702) 240-5595 for Part A and (702) 240-5510 for Part B Discussions. If you do not have a demand letter or a review results letter, but have concerns or questions, please contact our customer service area at the appropriate number below: Part A Providers, including Hospital, SNF and Hospice Telephone: (866) 590-5598 Fax: (702) 240-5595 Part B and DME Providers Telephone: (866) 376-2319 Fax: (702) 240-5510

What happens to the documentation and information that is submitted with the Discussion form?

The documentation and information is reviewed by the appropriate person at HDI and a determination is made to either uphold or overturn the overpayment. A letter is sent to the provider advising them of the determination. If HDI closes the finding after review of the Discussion information, HDI will work with the Medicare Claims Processing Contractor to close the AR or refund the monies if the offset has already occurred. The Discussion process does not impact the Medicare Claim Processing Contractor rebuttal or appeal process and does not stop recoupment.

How do I know that an account has been recouped?

The Medicare Claims Processing Contractor (“CPC”) will notify the provider via a Remittance Advice (“RA”) that it has established an Account Receivable (“AR”). The amount will be identified on the original RA as code N432. That is an indication that an AR has been set up and, if not paid back in 41 days, the CPC will recoup the amount with interest. After expiration of the forty one (41) day period, if payment is not made, the CPC will send a second RA in the amount that was recouped. We recommend that you retain the original RA for reference purposes.

Why can’t I access or login to my account on the HDI web portal?

For security purposes, providers and suppliers can only access HDI’s web portal using Internet Explorer 7.0, or higher, and Firefox 3.0, or higher. Internet Explorer 7.0 contains critical security updates not contained in earlier versions. If a provider has not upgraded to Internet Explorer 7, which was released in October, 2006, they will need to download the free software to access the web portal.

How will I know what issues the RAC is reviewing?

Once CMS approves an issue for review, HDI places the issue on the HDI website prior to any provider communications. Providers should regularly check the website for new issue updates.

Will HDI review only Medicare Fee for Service claims or will Medicare Advantage Claims also be reviewed?

RACs shall only review Medicare Fee for Service claims.

Why do I need to input my user name and password in the Provider Sign In area of the racinfo.com website to login?

CMS security requirements do not allow the storing of user names and passwords on the Provider Portal. You need to input your user name and password each time you login to the Provider Portal.

What states are included in HDI’s region?

Alaska, Arizona, California, South Dakota, North Dakota, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, Oregon, Utah, Washington and Wyoming

I know the RAC can review claims up to 3 years. Please explain how the 3 years period is determined.

Neither overpayments nor underpayments can be audited more than three (3) years past the initial claims paid date. • For complex reviews (where medical records are requested), the “look back” period is calculated by starting with the date the initial claim is paid and ends with the date the RAC issues the medical record request. Complex Review EXAMPLE: Claim date of service = 9/01-9/04/2007. Initial Claim payment date is = 10/4/2007. The RAC has up to 3 years from the initial claim paid date of 10/4/2007 to issue a medical record request (e.g., until 10/4/2010). If a medical request DATED on or before 10/4/2010 is received, it is within the “look back” period and the provider should promptly respond to the request. • For automated reviews, the “look back” period is calculated by starting with the initial claims paid date and ends with the date of the overpayment notification letter. Automated Review EXAMPLE: Claim date of service = 8/12/2007 Initial Claim payment date is = 1/18/2008 The RAC has up to 3 years from the initial claim paid date (1/18/2008) to issue a Demand Letter request (e.g., until 1/18/2011). If a Demand Letter DATED on or before 1/18/2011 is received, it is within the “look back” period and the provider should promptly respond to the request.

What is your Provider Relations toll-free number?

HDI’s contact numbers are as follows: Part A/Hospice: 866.590.5598 Part B/DME: 866.376.2319 Fax: Hospital & Hospice: 702.240.5595 Physician/DME: 702.240.5510

Why is the Knowledge Based Authentication (KBA) process used?

CMS has directed HealthDataInsights, Inc. (“HDI”) to allow providers to use a Knowledge Based Authentication method in order to securely access the HDI provider portal. The provider portal contains contact information for providers and enables providers to customize their contact information. It also contains the additional document request information as well as the receipt and review status of those records.

When does a provider need to use the Knowledge Based Authentication (KBA) to access the provider portal?

Part A Inpatient Hospitals (acute providers) were mailed a user name and password to access the HDI provider portal in 2009. If you already have a user name and password, it is not necessary to utilize the KBA method. Providers with a user name and password may sign in under “Provider Sign In”, located on the right side of the Login page. All other providers must initially utilize the Knowledge Based Authentication process to establish a password and gain access to the provider portal

What information can I access in the HDI Provider Portal?

After the login process, you have the ability to view and change contact information, view HDI requests for medical records and view the tracking of the medical records received.

How do I change/update provider contact information?

After the login process, you access the Account Management header and use the drop down box for Contact Information. Three columns of information appear. The first column is the Address from the Claims Processing Contractor (CPC) and can not be edited. The second column is the Contact to Receive Medical Record Request Letters. You may edit or delete contact information from this column. If you delete this information the contact will default to the CPC contact information. The third column is the Contact to Receive Improper Payment Letters. You may edit or delete contact information from this column as well. If you delete this information the contact will default to the CPC contact information. “Add Web Users” is found at the bottom of this page and allows up to a total of 7 Web Users. Please remember that any contact information in column 2 and/or column three is included in this total so if both columns are completed (even with the same information) you may only add 5 additional Web Users.

How do I track the status of the medical records I have sent to HDI?

After the login process, you access the Medical Record Tracking header. You are then directed to the Medical Record Tracking screen which provides the RAC Case ID, Medical Record Number, Date of Service From, Date of Service To, Documentation Requested (which indicates the date HDI requested the documentation), Documentation Received (which indicated the date HDI received the documentation), Review Results Letter Sent (which indicates the date the Review Results Letter was sent from HDI).

What is a Discussion period?

The Discussion period begins on the date set forth on the demand letter for automated reviews, or the date of the review results letter for complex reviews, and continues through the date the Claims Processing Contractor (“CPC”) recoups the amount (up to 41 days). The Discussion period offers Providers and Suppliers the opportunity to review the findings, and to provide HDI with additional information and/or documentation prior to recoupment by the CPC.

How do I open a Discussion with the RAC?

Before you can open a Discussion, you must have a demand letter (for automated reviews) or a review results letter (for complex reviews). Then, you obtain the Discussion form from the HDI provider portal at www.racinfo.healthdatainsights.com. The Discussion form is the first item after selecting the Provider Information tab. Fill in the information requested and submit any documentation and information that is pertinent to your case, to indicate why HDI should reconsider the finding. Fax the form and any documentation to HDI at (702) 240-5595 for Part A and (702) 240-5510 for Part B Discussions. If you do not have a demand letter or a review results letter, but have concerns or questions, please contact our customer service area at the appropriate number below: Part A Providers, including Hospital, SNF and Hospice Telephone: (866) 590-5598 Fax: (702) 240-5595 Part B and DME Providers Telephone: (866) 376-2319 Fax: (702) 240-5510

What happens to the documentation and information that is submitted with the Discussion form?

The documentation and information is reviewed by the appropriate person at HDI and a determination is made to either uphold or overturn the overpayment. A letter is sent to the provider advising them of the determination. If HDI closes the finding after review of the Discussion information, HDI will work with the Medicare Claims Processing Contractor to close the AR or refund the monies if the offset has already occurred. The Discussion process does not impact the Medicare Claim Processing Contractor rebuttal or appeal process and does not stop recoupment.

How do I know that an account has been recouped?

The Medicare Claims Processing Contractor (“CPC”) will notify the provider via a Remittance Advice (“RA”) that it has established an Account Receivable (“AR”). The amount will be identified on the original RA as code N432. That is an indication that an AR has been set up and, if not paid back in 41 days, the CPC will recoup the amount with interest. After expiration of the forty one (41) day period, if payment is not made, the CPC will send a second RA in the amount that was recouped. We recommend that you retain the original RA for reference purposes.

Why can’t I access or login to my account on the HDI web portal?

For security purposes, providers and suppliers can only access HDI’s web portal using Internet Explorer 7.0, or higher, and Firefox 3.0, or higher. Internet Explorer 7.0 contains critical security updates not contained in earlier versions. If a provider has not upgraded to Internet Explorer 7, which was released in October, 2006, they will need to download the free software to access the web portal.

How will I know what issues the RAC is reviewing?

Once CMS approves an issue for review, HDI places the issue on the HDI website prior to any provider communications. Providers should regularly check the website for new issue updates.

Will HDI review only Medicare Fee for Service claims or will Medicare Advantage Claims also be reviewed?

RACs shall only review Medicare Fee for Service claims.

Why do I need to input my user name and password in the Provider Sign In area of the racinfo.com website to login?

CMS security requirements do not allow the storing of user names and passwords on the Provider Portal. You need to input your user name and password each time you login to the Provider Portal.

What states are included in HDI’s region?

Alaska, Arizona, California, South Dakota, North Dakota, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, Oregon, Utah, Washington and Wyoming

I know the RAC can review claims up to 3 years. Please explain how the 3 years period is determined.

Neither overpayments nor underpayments can be audited more than three (3) years past the initial claims paid date. • For complex reviews (where medical records are requested), the “look back” period is calculated by starting with the date the initial claim is paid and ends with the date the RAC issues the medical record request. Complex Review EXAMPLE: Claim date of service = 9/01-9/04/2007. Initial Claim payment date is = 10/4/2007. The RAC has up to 3 years from the initial claim paid date of 10/4/2007 to issue a medical record request (e.g., until 10/4/2010). If a medical request DATED on or before 10/4/2010 is received, it is within the “look back” period and the provider should promptly respond to the request. • For automated reviews, the “look back” period is calculated by starting with the initial claims paid date and ends with the date of the overpayment notification letter. Automated Review EXAMPLE: Claim date of service = 8/12/2007 Initial Claim payment date is = 1/18/2008 The RAC has up to 3 years from the initial claim paid date (1/18/2008) to issue a Demand Letter request (e.g., until 1/18/2011). If a Demand Letter DATED on or before 1/18/2011 is received, it is within the “look back” period and the provider should promptly respond to the request.

What is your Provider Relations toll-free number?

HDI’s contact numbers are as follows: Part A/Hospice: 866.590.5598 Part B/DME: 866.376.2319 Fax: Hospital & Hospice: 702.240.5595 Physician/DME: 702.240.5510

Why is the Knowledge Based Authentication (KBA) process used?

CMS has directed HealthDataInsights, Inc. (“HDI”) to allow providers to use a Knowledge Based Authentication method in order to securely access the HDI provider portal. The provider portal contains contact information for providers and enables providers to customize their contact information. It also contains the additional document request information as well as the receipt and review status of those records.

When does a provider need to use the Knowledge Based Authentication (KBA) to access the provider portal?

Part A Inpatient Hospitals (acute providers) were mailed a user name and password to access the HDI provider portal in 2009. If you already have a user name and password, it is not necessary to utilize the KBA method. Providers with a user name and password may sign in under “Provider Sign In”, located on the right side of the Login page. All other providers must initially utilize the Knowledge Based Authentication process to establish a password and gain access to the provider portal

What information can I access in the HDI Provider Portal?

After the login process, you have the ability to view and change contact information, view HDI requests for medical records and view the tracking of the medical records received.

How do I change/update provider contact information?

After the login process, you access the Account Management header and use the drop down box for Contact Information. Three columns of information appear. The first column is the Address from the Claims Processing Contractor (CPC) and can not be edited. The second column is the Contact to Receive Medical Record Request Letters. You may edit or delete contact information from this column. If you delete this information the contact will default to the CPC contact information. The third column is the Contact to Receive Improper Payment Letters. You may edit or delete contact information from this column as well. If you delete this information the contact will default to the CPC contact information. “Add Web Users” is found at the bottom of this page and allows up to a total of 7 Web Users. Please remember that any contact information in column 2 and/or column three is included in this total so if both columns are completed (even with the same information) you may only add 5 additional Web Users.

How do I track the status of the medical records I have sent to HDI?

After the login process, you access the Medical Record Tracking header. You are then directed to the Medical Record Tracking screen which provides the RAC Case ID, Medical Record Number, Date of Service From, Date of Service To, Documentation Requested (which indicates the date HDI requested the documentation), Documentation Received (which indicated the date HDI received the documentation), Review Results Letter Sent (which indicates the date the Review Results Letter was sent from HDI).

What is a Discussion period?

The Discussion period begins on the date set forth on the demand letter for automated reviews, or the date of the review results letter for complex reviews, and continues through the date the Claims Processing Contractor (“CPC”) recoups the amount (up to 41 days). The Discussion period offers Providers and Suppliers the opportunity to review the findings, and to provide HDI with additional information and/or documentation prior to recoupment by the CPC.

How do I open a Discussion with the RAC?

Before you can open a Discussion, you must have a demand letter (for automated reviews) or a review results letter (for complex reviews). Then, you obtain the Discussion form from the HDI provider portal at www.racinfo.healthdatainsights.com. The Discussion form is the first item after selecting the Provider Information tab. Fill in the information requested and submit any documentation and information that is pertinent to your case, to indicate why HDI should reconsider the finding. Fax the form and any documentation to HDI at (702) 240-5595 for Part A and (702) 240-5510 for Part B Discussions. If you do not have a demand letter or a review results letter, but have concerns or questions, please contact our customer service area at the appropriate number below: Part A Providers, including Hospital, SNF and Hospice Telephone: (866) 590-5598 Fax: (702) 240-5595 Part B and DME Providers Telephone: (866) 376-2319 Fax: (702) 240-5510

What happens to the documentation and information that is submitted with the Discussion form?

The documentation and information is reviewed by the appropriate person at HDI and a determination is made to either uphold or overturn the overpayment. A letter is sent to the provider advising them of the determination. If HDI closes the finding after review of the Discussion information, HDI will work with the Medicare Claims Processing Contractor to close the AR or refund the monies if the offset has already occurred. The Discussion process does not impact the Medicare Claim Processing Contractor rebuttal or appeal process and does not stop recoupment.

How do I know that an account has been recouped?

The Medicare Claims Processing Contractor (“CPC”) will notify the provider via a Remittance Advice (“RA”) that it has established an Account Receivable (“AR”). The amount will be identified on the original RA as code N432. That is an indication that an AR has been set up and, if not paid back in 41 days, the CPC will recoup the amount with interest. After expiration of the forty one (41) day period, if payment is not made, the CPC will send a second RA in the amount that was recouped. We recommend that you retain the original RA for reference purposes.

Why can’t I access or login to my account on the HDI web portal?

For security purposes, providers and suppliers can only access HDI’s web portal using Internet Explorer 7.0, or higher, and Firefox 3.0, or higher. Internet Explorer 7.0 contains critical security updates not contained in earlier versions. If a provider has not upgraded to Internet Explorer 7, which was released in October, 2006, they will need to download the free software to access the web portal.

How will I know what issues the RAC is reviewing?

Once CMS approves an issue for review, HDI places the issue on the HDI website prior to any provider communications. Providers should regularly check the website for new issue updates.

Will HDI review only Medicare Fee for Service claims or will Medicare Advantage Claims also be reviewed?

RACs shall only review Medicare Fee for Service claims.

Why do I need to input my user name and password in the Provider Sign In area of the racinfo.com website to login?

CMS security requirements do not allow the storing of user names and passwords on the Provider Portal. You need to input your user name and password each time you login to the Provider Portal.