Burden of Compliance on Health Care Provider
First of all, the burden of compliance is on the health care provider, this means physicians, PAC's, FNP's, whoever is mainly responsible for the care of the patient. In the instance of a Medicare Audit, Medicare only offers superficial guidelines of compliance. They don't give any specific guidance to the medical professional providing care.
Guidelines Will Change
Secondly, coding and reimbursement guidelines are not static. They change, frequently at times. ICD-9 diagnosis codes and CPT procedure codes change every year, and additions and omissions are made to the codes. If someone is not paying attention to this, they are going to be making a huge mistake in their coding and billing by using outdated or even deleted codes, which could result in the patient or your practice being mistakenly charged thousands of dollars.
Be Prepared For The Inevitable
It only makes sense to be prepared for RAC audits. They aren't going away, so you it is up to you to stay up to date on the ever-changing policies. There can be significant money on the line because in a RAC audit money is taken according to mistakes that are made with the practice. These mistakes, for instance, could include incorrect coding. In any case, the money that is acquired from your practice is given to the RAC auditor. They certainly have a vested interest in finding errors, so shouldn't you have a vested interest in keeping your money within your practice? Physician practices need to be proactive in education and in auditing of their coding and billing, so as to protect themselves and their business. If there is an error that has been brought to your attention, you can always appeal after the fact, but being prepared ahead of time would be way more valuable and less time consuming for you.
Our company would have a vested interest in keeping your money within your practice. This is why your medical documentation services solution should provide pre-RAC audits. If is doesn't, or you just aren't sure, please feel free to contact us at any time, so we can start helping you save money and time.