The RAC Audit Is Coming To Your Practice – Are You Ready?
February 28, 2009
So you got the notice the Medicare RAC is coming to your practice. No big deal? Think again. The CMS audit of all beneficiaries of Medicare payments (i.e. – those who file claims with Medicare) is here to stay and if your practice is out of compliance, it could end up costing you thousands of dollars. It’s not all gloom and doom, however.
Follow a few simple rules to help get your practice prepared.
First, a bit about the RAC. In 2005 Congress authorized the Recovery Audit Contractor (RAC) program to do a demonstration in California, New York, Florida and 3 other states. The purpose – to discover areas of fraud and waste and recover overpayments made by Medicare due to improper coding and compliance with Medicare guidelines. The result – over $900 million in overpayments recovered and returned to the Medicare Trust Fund. With the success, Congress authorized the RAC program to be rolled out to all 50 states and Puerto Rico no later than January 1, 2010.
Don’t expect it to go away either … this program is to be permanently in place.
Anyone who files claims with Medicare, physicians, hospitals, home health agencies and durable medical equipment providers are all affected. What does this all mean to you? If you fall into one of the above categories, expect a notice soon from the contractor in charge of the audit in your region. Don’t expect them to tell you what they are looking for, however. That is left up to you. The RACs are compensated on a contingency basis based on the amount of overpayments that they find. You think they are going to be aggressive? You betcha! The penalties for overpayments? At the very least, overpayments will have to be returned. And Medicare isn’t going to send you an invoice and wait for the money…they will just take a portion of your current and future claims payments until the overpayment is paid in full. In extreme cases, Medicare may suspend a practices claims privileges all together.
Protect yourself by following a few easy procedures.
First, consider conducting an internal assessment of submitted claims to make sure they follow CMS guidelines. Either you, your staff, or a third-party auditor can do this. However, a qualified third-party auditor may be the best option as this allows for someone outside your practice to give you a second opinion. If you do choose to do it yourself, look for claims that have been denied in the past and and review the RAC’s website.
Consider having a certified coder review a sample of your files and help you identify any pattern of inconsistent or improper coding. Again, a third-party audit service is an excellent option. A qualified auditor should have certified coders on staff, preferably with government auditing experience as well.
Comply with Medicare’s request for medical records in a timely manner. Failure to do so may cost you the right to appeal any decisions by the RAC that you disagree with.
Finally, implement corrective actions to ensure compliance with Medicare guidelines prior to the RAC visit to your office. The sooner you do this, the less money you will cost yourself when the RAC finally gets around to you. If you choose to use a third-party auditor to assist you, they should provide you with a report on areas for improvement as well as consult with you on other areas of compliance as well.
With the right preparation and implementation of processes, you don’t have to be afraid of the RAC. Besides, some good may come out of your audit. During the same demonstration in the above mentioned states, $38 million in underpayments to providers was made. You may find areas where you have been underpayed, so it isn’t all bad news.
You can read more about the medicare audit and our medicare audit service
Fetch important info about legitimate home based businesses – give a look to quoted publication.
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