During RAC appeal, continue to follow carrier guidance

Why This Topic Matters

Providers need clear guidance on whether to follow carrier instructions or a RAC demand during an open appeal, since the answer affects ongoing billing, compliance, and possible repayment outcomes.

Article Sections

1. RAC appeals and carrier guidance

   Overview of the dispute between Medicare audit findings and carrier billing guidance, including the setting in which the issue arises.

2. Appeal process and claim handling

   Discussion of the general appeals process, how the carrier remains involved, and what happens while a determination is being reviewed.

3. Written documentation and waiver of liability

   Coverage of documentation support, the waiver of liability concept, and the role of CMS and carrier records in an audit dispute.

4. Practical considerations for ongoing billing

   General advice on reviewing current policy, evaluating disputed services, and considering outside assistance when needed.