Tracking Appeals and Reopenings

9.5.1.1 - Tracking Appeals and Reopenings (Rev. 921, Issued: 11-06-19 Effective: 11-04- 19, Implementation: 11-04-19) Appeals and reopenings requests received in response to a RAC initiated improper payment shall be tracked. The status of any appeals shall be tracked through all available levels of the appeal process. MCS and VMS contractors shall upload the weekly appeals report created in the standard systems to the RAC Data Warehouse no later than 2 business days after the end of the business week (typically Friday). FISS contractors shall complete the supplied Excel spreadsheet, see CR 7458, when reporting monthly appeals and reopenings information. The MAC/Contractor shall upload the Monthly Recovery Auditor Appeals and Reopenings Report to the RAC Data Warehouse by the 15th business day of each month. Questions concerning upload of the file can be sent to the RAC Data Warehouse Help Desk. The report shall include the prior month’s information and a copy shall be provided by email to the appropriate Recovery Auditor and the MAC COR. NOTE: CMS is in the process of modifying the Medicare Appeals System (MAS) to track first level Part A appeals. The implementation of MAS will occur individually. However, MACs shall continue to run and upload the MAS report to the RAC Data Warehouse. The MAC/Contractor shall include the additional tracking information supplied on the Excel monthly appeals and reopenings report. The MAC/Contactor shall record on the tracking report the rationale for the reversal. Reasons for Reversal Codes have been created and if one of the given codes is not appropriate, a narrative explanation shall be input. The MAC/Contractor shall research, fix and upload within 15 calendar days of notification all errors, including claims that do not get uploaded to the RAC Data Warehouse.