Protecting Your Practice Against RAC Audits With the Help of Efficient Medical Billing Practices

Efficient medical billing practices can make or break your medical practice and if anything can verify this statement, it is an RAC audit. RAC audits of Recovery Audit Contractor audits are nothing short of a nightmare for any healthcare provider.

Medicare and Medicaid are two healthcare carriers that provide coverage and reimburse physicians and hospitals for the services they provide to patients covered under these carriers. However, medical practitioners are known to receive over-payments due to incorrect claims or erroneous coding at the time of medical billing. In essence, government tries to ensure patients’ best interest and control the rate of fraud, error or wastage by putting RAC audits in place. But the resultant inconvenience caused to a medical practice in the event of an RAC audit is nothing short of disastrous.

Not only is error-free coding and meticulous book keeping of paramount importance, subsequent adjustment of office accounts can play an important role in case an RAC audit actually happens. To protect your practice against RAC audits, you must put efficient medical billing practices in place –

  • Follow correct coding for services –If a medical service is incorrectly coded for the sake of avoiding internal confusion or due to oversight and the incorrectly coded service is reimbursed by Medicare or Medicaid; then your practice can be in for an RAC audit. Transparent and efficient medical billing practices help you monitor coding of services on a regular basis and avoid simple yet latent disasters, hence with a little more attention, you can save your practice a lot of money and hassle.
  • File claims for correct payment amounts – Scrutinizing the final claim statement filed with healthcare carriers is of paramount importance. If the government settled an incorrect payment amount to your practice, as long as five years ago (as per recent healthcare reforms, the RAC audit period for overpayment has been extended from three years to five years) then your current financials can suffer drastically. Diligent book-keeping is a medical billing practice that can help you avoid this scenario altogether.
  • Avoid duplicate services – It may not be fraud at all, but mention of duplicate services is rarely ever seen as an honest human error by an auditor. A prudent medical billing practice is installing audit software or enlisting the service of a compliance auditor, to fix your errors before an actual audit.

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  • Don’t claim for non covered services – Services that are not necessary and reasonable under section 1862(a) (1) (A) of the social security act are not meant to be reimbursed by Medicare or Medicaid. Avoiding inclusion of the same in your claim amount can save you from a potential audit. an expert in medical billing and coding serving the healthcare industry for more than decade now can help protect your practice from potential RAC audits by offering immaculate medical billing consultancy and services.

RAC auditors conduct audits on providers in response to insider information or complaints, upon diagnosing irregularities in billing and coding practices as per the CERT or other CMS analysis. With comprehensive and efficient medical billing practices in place with the help of our experienced medical billers and coders, our client’s practices are well equipped with all the required defenses in place to protect themselves against an RAC audit.