Adjusting the Claim

9.5 - Adjusting the Claim (Rev. 921, Issued: 11-06-19 Effective: 11-04- 19, Implementation: 11-04-19) The MAC shall process RAC-initiated overpayments the same as any overpayment determined by the MAC. The RAC shall submit claim adjustments directly to the Virtual Data Centers (VDCs) via the file-based mass adjustment process. Manual adjustments shall be limited to those that cannot be accommodated through more automated means. The MAC shall identify the origin of any manual adjustments by assigning RAC adjustment reasons and/or discovery codes as appropriate. The MAC shall create an accounts receivable in accordance with the guidelines in the Medicare Financial Management Manual (MFMM), Publication 100-06, Chapter 4, Sections 20 and 80. The MAC shall issue all demand letters for any RAC identified overpayment, following the same process as for any other payment recoupment. The MAC shall include the initiating RAC’s name and contact information in all demand letters. The MAC shall be responsible for fielding any administrative concerns related to the claim adjustment, such as, the issuance of demand letters, timeframes for recoupment and the appeals process. The RAC shall be responsible for any audit specific communications, such as reviewer rationale inquiries and discussion requests.