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Can I win RAC appeals using legal or procedural arguments?

April 26, 2017appeals Legal procedural RAC Win

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Can I win RAC appeals using legal or procedural arguments?

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A. Rarely. Legal or procedural arguments sound good, but rarely are effective when challenging CMS payment criteria. The U.S. courts have held on multiple occasions that CMS defines the scope of coverage for beneficiaries. Contact one of our experienced Medicare consultants or Medicare lawyers for more detailed information.