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You are here: Home / Articles / Tips on Audits

Tips on Audits

June 1, 2010 • By From the College

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”Recovery Audit Contractor” (RAC) is a term that every healthcare professional and staff member who deals with Medicare needs to know.

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RACs were created as part of the CMS Medicare Integrity Program. Under this program, CMS is taking all possible steps to ensure that practices are submitting proper claims for reimbursement. The initial phase of CMS’ Medicare Integrity Program has been completed and is now operational in all 50 states.

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Physicians aren’t likely to feel the full effects of the RAC for at least a year, but practices should start to take steps now to guard against audits. Here’s what you need to know:

  • RACs are looking for improper payments, not fraud, but they will turn over obvious cases of fraud to the government;
  • RACs will be able to audit E/M codes, but the American Medical Association is working with CMS to limit their reach in this area; and
  • Rheumatology practices should perform regular self-reviews of coding and billing as part of their compliance plan. Practices should take the proper steps to correct any problems they find.

Regardless of how well you prepare and how honest you are, a RAC may still come your way. In some cases, they might simply find that your coding levels are higher than those of your peers because of the kind of work you do or the nature of your patient base. Just remember, the best defense is good documentation. If you would like to have the ACR coder review a sample of your charts for documentation guidelines, contact Melesia Tillman at mtillman@rheumatology.org or (404) 633-3777, ext 820.

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Filed Under: From the College, Practice Management Tagged With: Audits, Centers for Medicare and Medicaid Services, CMS, Recovery Audit ContractorIssue: June 2010

You Might Also Like:
  • Recovery Audit Contractors: What Are the Facts?
  • Audited by a Recovery Auditor Contractor—Now What?
  • Understanding & Preparing for Payer Audits
  • Practice Page

Rheumatology Research Foundation

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Learn more about the ACR’s public awareness campaign and how you can get involved. Help increase visibility of rheumatic diseases and decrease the number of people left untreated.

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ISSN 1931-3268 (print)
ISSN 1931-3209 (online)

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