AAHomecare Alert: RAC Is Wrong in CPAP Audits

ARLINGTON, Va. — According to a late Friday message from
the American Association for Homecare, RAC audits in Jurisdiction D
are targeting CPAP equipment and supplies for recoupment when the
Medicare program did not pay for the sleep test.

“The association is very concerned that because CPAP therapy is
frequently prescribed prior to an individual becoming Medicare
eligible, many providers who furnish replacement equipment and
supplies will be targeted for recoupment,” the message said.

Based on advice from its CPAP workgroup, the association had
these recommendations and reminders for HME providers targeted for
such a RAC audit:

• 1) Make sure it is a RAC audit.
• 2) Remittance advice remark code N432 is used to identify RAC
  adjustments. This code appears on the claim level header detail
  line of your Medicare remittance advice.
• 3) Offset of the overpayment will occur on day 41 from the date
  of the demand letter if payment has not been made or there a
  request for an appeal.
• 4) File a Medicare DME redetermination request form.

AAHomecare said it is bringing up the issue with DME MAC
officials in Jurisdiction D (Noridian Administrative Services) as
well as CMS staff who oversee RAC activities “in an effort to
correct the interpretation now being applied by the RAC
contractor.”

Health Data Insights is the RAC contractor in Jurisdiction
D.