Audit Guard RAC Baseline Audit and CodeRite
Overview
In March 5, 2009 the government employed four (4) private firms to perform medical records and billings audits in all 50 states, this is known as the Recovery Audit Contract (RAC). If a provider bills Fee-for-Service Medicare, Medicaid or Commercial Insurance programs, their claims will be subject to review by these auditors.
The purpose of these audits is to identify:
- Documentation and coding inconsistencies.
- Overpayments (& Underpayments) made to the providers.
- Clear documentation to support medical necessity of the services being provided.
RAC has found over $1billion of identified overpayments in 3 states in only ONE year!
If your practice is found to have inconsistencies in coding or improper documentation regarding the need for service, you will be obligated to pay the overpayment + interest within 30 days of notification. There have only been 7.6% successful appeals. In addition, the exact same audit process will occur every 45 days until the auditors find no more conflicts or inconsistencies. The solution is Audit Guard - RAC Baseline Audit.
Audit Guard cannot prevent your practice from being audited but it is a service that can prepare you for a RAC audit.
Audit Guard services consist of:
- Review 50 random records to identify improper coding and non-compliance with Medicare/Medicaid
- Outline corrective actions required for compliance
- Implement change required to stay in compliance
- Assist provider with training programs to ensure documentation compliance
- Provide assistance in the event of a RAC audit
RAC is serious - providers need to know and understand the risks and implications. Audit Guard is the solution.
CodeRite is a service to provide medical coding in accordance with ICD-9CM, CPT, CMS and HCPCS standards. While medical providers and their staff are trained on coding standards, these codes are frequently modified and the requirements to assign specific codes to encounters are changed. Incorrectly assigning a diagnosis code or procedure code could result in decreased revenue (under coding), and denied insurance claims because the diagnosis and procedure don’t match. Incorrect coding will result in underpayment, no payment, or overpayment with possible legal action taken by payers against the medical provider (ie. RAC audits).
 The solution to this problem is CodeRite, ‘Coding as a Service’. This service provides your practice with Certified Professional Coders to code your medical providers encounter notes. We will provide you with the diagnosis code (ICD-9CM), procedure code (CPT) and modifiers which you can place into your billing software to get paid by the insurance companies in a timely manner.
Contact Medicus Reimbursement, LLC for more information on Audit Guard or CodeRite.
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