The Rac Audit Is Coming To Your Practice: Now What?
So you got the notice...the Medicare RAC is coming to your practice. Not worried? Think again. The CMS audit of all beneficiaries of Medicare payments (anyone who files medical claims with Medicare) is here to stay and if your practice is out of compliance, it could end up costing your practice. It doesn't have to be all bad news, however. Follow a few simple steps to help get prepared.
First, a little about the RAC. In 2005 Congress authorized the Recovery Audit Contractor (RAC) program to do a demonstration in 3 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. Because of these results, Congress authorized the RAC program to be rolled out to all 50 states and Puerto Rico no later than January 1, 2010.
Don't bet on it going away...The RAC audit is a permanent program.
Any medical provider who files claims with Medicare - doctors, 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, be prepared to get a notice soon from the contractor in charge of the audit in your region. The RACs are paid on a contingency basis based on the percent of overpayments that they find. Think they are going to look hard at your claims? Without a doubt! The penalties for being out of compliance? 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 take a portion of your current and future claims payments until the overpayment is paid in full. If compliance issues are profound, CMS may suspend a practice's claims privileges all together.
Here's how to make sure you are covered.
First, consider conducting an internal assessment of all of your claims to make sure they follow Medicare rules. Either you, your staff, or a third-party auditor can do this. However, a certified third-party auditor may be the best option as this allows for someone with an unbiased look to give you another opinion. If you do choose to do it yourself, look for claims that have been denied in the past and review the CMS RAC website.
Think about having a certified coder review a sample of your charts and help you identify any pattern of inconsistent or errors in 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.
Respond to 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 measures to ensure compliance with CMS guidelines prior to the RAC visit to your office. The sooner you do this, the less money you will cost yourself when the RAC visits you. If you choose to use a third-party auditor to help 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 fear 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 there are positive opportunities as well.
First, a little about the RAC. In 2005 Congress authorized the Recovery Audit Contractor (RAC) program to do a demonstration in 3 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. Because of these results, Congress authorized the RAC program to be rolled out to all 50 states and Puerto Rico no later than January 1, 2010.
Don't bet on it going away...The RAC audit is a permanent program.
Any medical provider who files claims with Medicare - doctors, 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, be prepared to get a notice soon from the contractor in charge of the audit in your region. The RACs are paid on a contingency basis based on the percent of overpayments that they find. Think they are going to look hard at your claims? Without a doubt! The penalties for being out of compliance? 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 take a portion of your current and future claims payments until the overpayment is paid in full. If compliance issues are profound, CMS may suspend a practice's claims privileges all together.
Here's how to make sure you are covered.
First, consider conducting an internal assessment of all of your claims to make sure they follow Medicare rules. Either you, your staff, or a third-party auditor can do this. However, a certified third-party auditor may be the best option as this allows for someone with an unbiased look to give you another opinion. If you do choose to do it yourself, look for claims that have been denied in the past and review the CMS RAC website.
Think about having a certified coder review a sample of your charts and help you identify any pattern of inconsistent or errors in 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.
Respond to 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 measures to ensure compliance with CMS guidelines prior to the RAC visit to your office. The sooner you do this, the less money you will cost yourself when the RAC visits you. If you choose to use a third-party auditor to help 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 fear 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 there are positive opportunities as well.
Source...