Big Payoff For Being Prepared For a RAC Audit By Emily Leach At Isnare.com Ezine Articles

A Recovery Audit Contractor (RAC) can create complete chaos in a company when you are not prepared. In 2003 Congress directed the Department of Health and Human Services (DHHS) to conduct a 3-year demonstration program to detect and correct improper payments in the Medicare program. And by the end of this demonstration program reclaimed over a billion dollars in overpayments. If you facility is audited and found to have received overpayments you are looking at fines on top of paying it all back.

This could put some small practices out of business if they aren’t on top of their Medicare and Medicaid claim requirements. Because the 2003 demonstration program was so successful it is here to stay in order to continue to identify improper payments of Medicare and Medicaid health care services claims. Improper payments include overpayments as well as underpayments … are you tracking every claim to make sure your coding matches the policy requirements. If not, and your medical facility received full payment due to oversight you could be in for some hefty fines and repayment.

So how can you be prepared?

Use a system that will manage the claims process with an integrated RAC requirements tracking. The OnBase RAC Audit Tracking system auto-calculates requests and tracks the steps to be completed, who it’s assigned to, expected completion date, appeal dates and more. RAC audits are looking for overpayment determinations that can come from a lack of proof of medical necessity. Without the right information (lab results, clinical information, progress notes, etc.), you don’t have the proof to prevent overpayment determinations. An overpayment or underpayment determination can also come from claims that were submitted that did meet the coding requirements for Medicare or Medicaid.

Even hiring an employee to track your RAC audit requirements has problems; we all know that humans sometime miss a detail. It only takes one mistake to pile up without ever realizing it. By implementing a proven system designed specifically for the RAC audit your medical facility can rest assured you are in check.

You can scan in all of the paper records in to one repository to make record tracking simple; and even better, making a RAC audit a breeze. Just take the auditor to your records tracking system with no need for spending hours gathering and organizing paper documents. You maintain all of the information to justify every incoming payment in place. If you have an appeal from before you implemented a tracking system you now have all of your ducks in a row after implementation and have increased your chances of winning that appeal.

The Recovery Audit Contractor (RAC) program will be expanded to all 50 states by the end of 2010, not leaving you a lot of time to get your medical billing system in check. OnBase RAC audit Tracking system removes the need to bring on additional help if you are tagged for an audit. And having a system in place that walks you through the process on every claim and flags coding that will not meet the requirements for Medicare or Medicaid will save your office time now and later.

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