The Recovery Audit Contractor, or RAC, program was created through the Medicare Modernization Act of 2003 (MMA) to identify and recover improper Medicare payments paid to healthcare providers under fee-for-service (FFS) Medicare plans. The United States Department of Health and Human Services (DHHS) was required by law to make the program permanent for all states by January 1, 2010, under section 302 of the Tax Relief and Health Care Act of 2006.
Their purpose is to track the accuracy of Medicare claims by auditing for overpayments and underpayments (residing under the Social Security Act). Medicare has contracted with RACs, enabling them to audit any health care provider in the U.S. that files Medicare claims. The audit and recovery plan is expected to be in place on a permanent basis. Based on findings, if compliance with Medicare billing rules are not up to standard, penalties may be assessed to the practice. In severe cases, loss of Medicare billing privileges can be revoked.
Learn more about RAC Audits and how they can affect your practice.
Protecting Your Practice from Audits
You have heard the adage, “The best offense is a great defense!” An initial first step would be to identify areas of vulnerability along with any anomalies that could result in your practice undergoing a coding audit. Proper coding and billing patterns, as well as utilizing fully compliant transcription and documentation will further protect your practice. Unfortunately, a vast majority of hospitals and physician practices do not have the internal resources to successfully avoid becoming vulnerable and at risk.
Learn more about Protecting your Practice from RACs.
M-Scribe Audit Programs
Since future behavior can sometimes be predicted by evaluating the past, M-Scribe’s Audit Program will assign an audit specialist to review every patient record for the past six months. This includes procedure and diagnosis codes, documentation and other relevant information. Their objective is to ensure your practice is abiding with required compliance regulation. Once the assessment is completed, next steps will be determined to reduce future susceptibility.
More about M-Scribe Audit Programs
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FREE RAC Audit Checklist