The Medicare RAC audits have begun, and will continue on an ongoing basis.
By now you are probably aware of the Medicare RAC audits. A pilot program was initially done in 3 states, California, Florida and New York. The focus was strictly on hospitals in that pilot program with the exception of Florida, where 2% of the audits were also on physicians. The test was deemed a success as $900 million in overpayments by Medicare were returned to the US Treasury.
Congress mandated going forward that the RAC audit be rolled out to all 50 states and Puerto Rico no later than January of 2010. All providers who accept Medicare payments are to be audited. It is not a matter of if you will be contacted, but when will you be contacted?
If you do not have a compliance plan in place, now is the time to prepare one. If you do have a compliance plan in place, now is a good time to have it reviewed.
The Medicare RAC auditors are paid on a contingency basis. What this means is they are compensated to find errors. You do have the right to appeal their findings, but anyone who has gone through the appeals process with Medicare knows how frustrating that can be. The auditors are looking at your coding and documentation, and checking for medical necessity. If you do not know or are not sure what they want to see, you could be leaving a lot to chance. What you know is medical necessity for your patient could be interpreted differently by the RACs if your documentation is not what they want to see.
What is more, if your compliance is found to be below standard, Medicare will be back every 45 days with requests for more charts and documentation until standards are met. Not only is this a headache for you and your staff, but it can be quite costly as well.
A third-party audit review by an experienced firm prior to the RAC visit can save you thousands and pay for itself several times over.
Just like you may order an x-ray or other test to see what is really going on with your patient, there are tests to see what is really going on with your practice and your cash-flow. Even if you have your own internal audit process in place ( and it is a good idea to have ), an independent third-party review can give you a base idea of where you are at and where you need to be with your compliance.
The sooner you do this, the better. Any compliance errors you can catch and eliminate in advance of the RAC visit could add up to thousands of dollars in repayments to Medicare you can avoid. What is more, we find that approximately 15% of providers also find coding or compliance errors in which they were underpaid and are able to file for reimbursement from Medicare.
Here is a great article that demonstrates why doing an independent audit review of your claims is vital. Read Why Doctors Are Abandoning Medicare
For more information about how we can help protect you with our Audit Guard review click here
For details and a list of provider webinars available, click here
For more information on the RAC program, you can visit the CMS site here
To find your RAC contractor's website, get the latest approved issues in your region, and most recent updates, click here
