3 Things You Can Do Today to Prepare for a RAC Audit

face audits by being prepared

What’s the first think you think of when you hear Recovery Audit Contractor? RACs have been around for a while (and not without controversy) as part of a Medicare program to find and correct past improper payments. Even folks who don’t get nervous at the thought of an audit probably don’t look forward to the extra work involved and the lengthy appeals process. There are some small steps you can take now to help make that mountain of an audit less intimidating.

1. Monitor Approved RAC Issues

If you haven’t checked your RAC’s approved issues in a while, it’s time to make a date with the contractor’s website. Some experts advise checking for new issues once a month or so.

Example: If you code for a physician in Performant Recovery’s region, you can go to the Approved Issues page and review the issues for your provider type, like payment for a global service along with payment for the service’s professional or technical component. RAC audits look at past claims, but you can still use the approved issue information to self-audit and to inform your training.

2. Pay Attention to LCDS and NCDs

Approved issues often relate to specific LCD and NCD requirements, so you’ll need to look beyond the approved issues page and delve into exactly what the policies say. (Which is just good coding, anyway, right?)

Example:Cotiviti lists Medical Necessity Sacral Neurostimulation as an approved issue. Reviewers check documentation to see whether the service meets coverage criteria, coding guidelines, and medical necessity requirements. The details section for the approved issue lists the specific NCD and LCD policies the review is based on, helping to direct you to the policies you need to know.

Bonus: The more you comply with Medicare rules, the lower your RAC work may be. Here’s why: The RAC program involves Additional Documentation Request (ADR) limits. For instance, a RAC can request only a certain percent of your paid claims in a specified period. The Statement of Work CMS published for RAC regions 1-4 states, “CMS will establish a method to adjust the ADR limits based on a provider’s compliance with Medicare rules.” If your denial rates are low, your ADR limit will be low. If your denial rates are high, then your ADR limit will be high, meaning the RAC can ask for a larger amount of information.

3. Create an Audit Team

Plan now so you don’t have to scramble to meet audit requests later.

For instance: Decide who will be responsible for alerting staff to deadlines, pulling records, and going through documentation before submission. Be sure team members know what they’ll be responsible for so they know what to expect. You also can identify experts from your team and from outside your organization to assist with an audit defense, if needed.

How About You?

Have you been through a RAC audit? What advice do you have for others?

About 

Deborah concentrates on coding and compliance for radiology and cardiology, including the tricky world of interventional procedures, as well as oncology and hematology. Since joining The Coding Institute in 2004, she’s also covered the ins and outs of coding for orthopedics, audiology, skilled nursing facilities (SNFs), and more.

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1 Comments For This Post

  1. ROSEANN GIBBS Says:

    hello,
    we use Scribes in our ED. There are no set guidelines that i am aware of, so I was wondering if you have any documentation regarding the responsibilities of scribes

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