{"id":921,"date":"2013-06-17T11:54:47","date_gmt":"2013-06-17T11:54:47","guid":{"rendered":"https:\/\/www.billingparadise.com\/blog\/?p=921"},"modified":"2023-03-24T02:19:19","modified_gmt":"2023-03-24T07:19:19","slug":"5-crucial-tactics-to-avoidsurvive-a-medicare-rac-audit","status":"publish","type":"post","link":"https:\/\/www.billingparadise.com\/blog\/5-crucial-tactics-to-avoidsurvive-a-medicare-rac-audit\/","title":{"rendered":"Survive or Avoid Medicare RAC audit using 5 key tactics"},"content":{"rendered":"

\u00a0 \u00a0 \u00a0\u00a0<\/i><\/p>\n

<\/i>If there has been one coffer that has been jingling right through the so-called economic downturn it surely has to be this.\u00a0 No!!\u00a0 We don\u2019t mean the Federal Reserve, but the rather humbler Medicare Recovery Audit Program or RAC in short.\u00a0 The first quarter of this year has yielded a magnificent $ 750 million, nearly $100 million more than the last.\u00a0 So, it looks like at least someone is doing their homework when it comes to healthcare.<\/strong><\/p>\n

But unfortunately, this is certainly not good news for the various hospitals, small clinics, and independent practitioners, already reeling under the effects of reduced payments from the federal insurance programs.\u00a0 More than anything it only serves to prove that payment criteria have become very stringent and non-adherers have to pay a heavy price.\u00a0 It has been estimated that since the starting of the program a whopping $4 billion dollars has been extracted by the four RAC Auditors; Connolly, DCS, HealthData Insights, and CGI.\u00a0<\/strong><\/p>\n

\u00a0<\/span><\/b>Some Important Facts about RAC Audits<\/span><\/b>:\u00a0<\/span><\/h2>\n

 <\/p>\n

\u00a0\"audits\"<\/a><\/p>\n

1.\u00a0 A hospital or a clinic may have to spend upwards of $40,000\/year to manage a RAC process.<\/strong><\/p>\n

2.\u00a0 Outpatient billing errors contributed to over 40 percent of the dollars recovered.<\/p>\n

3.\u00a0 Cardiovascular procedures topped the list in overpayment recovery, while minor procedures and other treatments billed as inpatient when an outpatient setting would have sufficed, came in next.<\/p>\n

4.\u00a0 Your hospital\/clinical staff might have to spend nearly 500 hours a year dealing with the RAC process.<\/strong><\/p>\n

5.\u00a0 Another version of improper CMS payments involves the transfer of funds in the opposite direction.\u00a0 Providers are being underpaid by nearly $300 million every year by Medicare,<\/strong> unless there is an internal process in your clinic to deal with it.<\/p>\n

5 Crucial Tactics To Be Followed:<\/span><\/b><\/span><\/h2>\n

a.\u00a0 Know Your Curve:<\/strong>\u00a0 RAC\u2019s use complex software and\/or complex audit practices to determine if you are overcoding.\u00a0 Thus if your codes fall outside that nice fat region of a Bell\u2019s Curve for Procedural Codes, chances are high that you may have garnered unnecessary and harmful attention from CMS.\u00a0 Thus, make sure your inhouse medical coding team or your outsourced medical coding vendor <\/i>does not use the more general codes without a solid rationale, and follows the most important thumb rule of a medical coding process, <\/i>which is going for the next highest code for more specificity.<\/p>\n

b.\u00a0 Modifiers:<\/strong>\u00a0 Modifiers, especially 59 & 25, need to be used judiciously since they mainly accompany outliers, and thus may drawn unsolicited attention.<\/strong><\/p>\n

c.\u00a0 Satisfied Patients:<\/strong>\u00a0 Don\u2019t send back grumpy patients, who may call up the payer\u2019s office (including CMS) often times and direct their roving eyes onto your practice. \u00a0Exquisite patient support desk should significantly decrease the chances of the above, and even at times when patients are not happy about certain charges billed to them, they would contact your clinical staff first rather than take it up with the payers.<\/p>\n

d.\u00a0 Compliance Plan:<\/strong>\u00a0 Your clinic needs an internal compliance program just to make sure your medical billing team<\/i> or medical coding team<\/i> is functioning properly.\u00a0 This makes sense even if there had been no RAC guillotine hanging over your head.\u00a0 That is because a pursuit of quality and setting internal benchmarks for the same is going to aid any process\u2019s growth in the long run.<\/p>\n

e.\u00a0 EHR Awareness:<\/strong>\u00a0 Make sure your clinical staff know their way around the various templates of your EHR; else there is every possibility that some redundant material from an altogether different patient may make its way into an unrelated patient\u2019s electronic medical records.\u00a0 A partnership with an EHR Support Vendor<\/i> to help you gain this awareness may also be a good idea.<\/p>\n

CONCLUSION<\/b>:<\/span>\u00a0 Finally, if you find that your internal medical billing and coding<\/i> staff are unable to cover all of the above ground; it would be wiser and certainly simpler to transfer this responsibility onto an existent medical billing vendor<\/i>.\u00a0 As experts in the medical billing<\/i> domain they stand a better chance in helping you to implement the above, and thus aid you in avoiding\/getting through an RAC audit.<\/p>\n

\n","protected":false},"excerpt":{"rendered":"

\u00a0 \u00a0 \u00a0\u00a0 If there has been one coffer that has been jingling right through the so-called economic downturn it surely has to be this.\u00a0 No!!\u00a0 We don\u2019t mean the Federal Reserve, but the rather humbler Medicare Recovery Audit Program or RAC in short.\u00a0 The first quarter of this year has yielded a magnificent $ […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[744],"tags":[],"class_list":["post-921","post","type-post","status-publish","format-standard","hentry","category-rcm"],"_links":{"self":[{"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/posts\/921","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/comments?post=921"}],"version-history":[{"count":1,"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/posts\/921\/revisions"}],"predecessor-version":[{"id":442271,"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/posts\/921\/revisions\/442271"}],"wp:attachment":[{"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/media?parent=921"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/categories?post=921"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/tags?post=921"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}