RAC Audit Response Process Template
Four documents and three sheets that track both clocks a demand letter starts and rank the disputed charts by what each is actually worth.
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Appeal Deadline Tracker
Two dates, and the letter carries one of them
Level one of a fictional postpayment demand against Harrowdene Medical Associates. Every date below is computed from the notice, not copied off it.
| Demand letter dated | 14 September 2026 | Amount demanded | $281,523 |
| Receipt basis | Presumed, notice date plus five | Receipt date | 19 September 2026 |
| Clock | Date | Derived from | On the letter |
|---|---|---|---|
| Recoupment may begin | 25 October 2026 | Demand date plus 41 days | No |
| Redetermination filable through | 17 January 2027 | Receipt plus 120 days | Yes |
84 days in which the appeal is live and the money is moving
Harrowdene collects about $41,000 a week from Medicare. At that rate the whole $281,523 is recoverable by 12 December 2026, with 36 days still left to file.
Remaining columns: Case Reference, Receipt Evidence, Filing Deadline Source, Recoupment Source, Sampled Claims Live, Filed On, Days Early, Confirmation, Outcome, Owner.
Every guide to the RAC audit response process gives the same instructions: date-stamp the letter, calendar the deadline, send an indexed bundle by a trackable method. All correct, and all about the one date printed on the page. A Medicare demand letter starts a second clock it never mentions. Contractors can begin recoupment no earlier than 41 days from the initial overpayment demand, and must stop on a timely and valid redetermination request. The appeal stays filable for 120 calendar days from receipt, around eighty days later.
The second thing nobody does is arithmetic. Where a demand is extrapolated from a statistical sample, every sampled claim carries the whole multiplier, so the disputed charts are worth wildly different amounts for reasons unrelated to what was billed. This pack puts the extrapolated value on each row and crosses it against a column no worklist keeps. Is the element the reviewer named in the note and simply not sent, in the note and read differently, or not there at all? Three answers, three different people, three different odds.
Harrowdene Medical Associates drew a postpayment demand of $281,523, extrapolated from 40 sampled claims out of a universe of 3,142. The sample's own findings came to $3,584, so every dollar of sample finding carries $78.55 of demand. Crossed against the charts, $110,834 of it, 39 percent, sits on nine claims where the element the reviewer wanted was already in the note and was never sent. The smallest finding in the sample was $47 and is worth $3,692. The largest claim in the universe, billed at $1,240, was not drawn and is worth nothing.
What's in the pack
Request to Record Map
One row per requested claim, carrying the payer's own stated reason, the named document that answers it, and one of four record statuses. Sorting by reason and counting the statuses inside each group is the finding.
Appeal Deadline Tracker
Both dates at every level with the source of each, and the gap between them in days. Reconsideration runs 180 calendar days from receipt while recoupment resumes on the 60th day after an affirming redetermination.
Counsel Escalation Trigger
Ten conditions written before any letter arrived, checked on the day one does, each marked met or not met against the line of the notice that decided it.
Records Index
One line per document with its date, author, page range and the specific element it answers, so a four hundred page bundle stays navigable by somebody who was not there when it was built.
Production Log
One row per tranche with the delivery evidence attached, and a column recording that somebody checked the bundle for internal working papers before it went.
Response Letter
A factual transmittal that answers what was asked and stops. No concession, no argument, no volunteered account of how the practice documents anything.
Internal Assessment Note
The honest read of what the charts show, written for the practice and its advisers, kept out of the production. Its last section routes the process findings into a coding review so fixing them never waits for the audit to close.
Audit Deadline and Recoupment Watch
A weekly recompute of both dates on every open row, plus sampled claims still unweighted and any live claim count that fell without a decision recorded against it.
How to use it
- 1
Open in River, or download it
Open the pack in River and let the agent read the notice and build the map, or download the blank Word and CSV files instantly and work through them yourself.
- 2
Send the notice before anything else
What kind of notice it is decides whether the next two weeks are administrative work or something that needs counsel today. The escalation list gets checked here, before anybody is invested in a plan.
- 3
Set both clocks on day one
Filing deadline from the notice date and the receipt basis. Recoupment date from the demand date. Same row, with the gap in days, and the regulation or contract clause behind each.
- 4
Map, weight, then work in that order
One row per requested claim with the payer's reason and the answering document, the multiplier on every sampled row, and the chart hours spent from the top of that column down.
Frequently asked questions
Is this template free?
Yes. Download the whole pack as Word documents and CSV sheets with no credit card. "Edit with AI" is a separate, optional path for practices that want the agent to read the notice and build the map from their own records. Other packs are in the template library.
What format are the downloaded files?
Word documents (.docx) for the response letter, the records index, the internal assessment note and the escalation trigger, and CSV (.csv) for the three sheets, zipped into one file. They open natively in Word, Pages, Google Docs, Excel, Numbers and Sheets.
Why track a recoupment date separately from the appeal deadline?
Because they are different dates and only one is printed. A Medicare contractor may begin recoupment no earlier than 41 days from the demand and must cease on receipt of a timely and valid redetermination request, so filing is what stops it. Filing on day 100 is entirely within the appeal right and roughly eighty days of withholding late.
Does this pack tell me whether to appeal?
No. It computes dates, maps a request to the records that exist, and weights sampled claims. Whether to appeal, whether care was medically necessary and whether coding was correct are for the practice, its clinicians and its advisers. The escalation trigger makes sure that call gets made, and a pattern across claims belongs in the compliance program afterward.
What changes if the demand is extrapolated from a sample?
Every sampled claim carries the multiplier, so the chart work reorders and a concession costs the multiplier rather than the claim. It also drops that claim from later levels: an appellant must file for each sampled claim it wishes to appeal in one request. Without a sample the multiplier is one. A lone denial belongs in the denial appeal pack.
Does this work for a commercial payer audit?
The map, the index, the production log and the escalation trigger transfer without change. The deadlines do not. Commercial timeframes come from the plan's policy and the contract, are frequently shorter, and the tracker records the clause behind every date so nothing is carried across by assumption.
What does 'Edit with AI' actually do?
It creates a free River account, installs this exact pack as a private workspace, and opens it ready to read whatever you send. Nothing is written until you send something. The policies and evidence an auditor asks for before any of this happens are a separate pack, as is the security risk analysis.
Both clocks, and the charts that are actually worth the hours
Download the blank pack as Word and CSV files, or open this exact pack in River and let the agent read the notice and set both dates first.
Edit with AI