Coding Audits

In 2010, the federal government implemented the nationwide “Recovery Audit Contract (RAC),” a control process intended to weed out the large volume of fraudulent medical claims. To accomplish this, the government hires private auditing companies to perform audits on medical records and claims billing. Audits may cover any provider who bills fee-for-service Medicare, Medicaid, or commercial insurance programs. The audits will check for evidence of fraud by examining three common indicators of fraud: 1) coding inconsistencies; 2) documentation to support the medical necessity of the services provided; and 3) overpayments or underpayments to  providers.

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This is a critical procedure for all medical practices. If your practice’s claims and records are audited and any of the three inconsistencies are found, you will be required to pay back any overpayment plus interest. Appeals are often unsuccessful, and the auditing companies will continue to audit your practice every 45 days until they find no further evidence of fraud.

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The RAC program identified approximately $265 million in overpayments in 2020. Why take a risk in your practice? Begin using our MD Audit Shield services to eliminate the chances of an audit proving inconsistencies in your billing. While nothing will keep the government from auditing your practice, our MD Audit Shield service will at least protect your practice in several ways. MD Audit Shield takes the following steps to ensure your compliance:

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• It reviews 50 records at random from your billing to check if any improper coding and non-compliance issues with Medicare/Medicaid appear.

• It specifies what corrective actions are needed to comply with codes.

• It performs any necessary changes to put you in compliance.

• It stands behind you with assistance in the event you are audited.

 

Please contact us today to prepare for RAC auditing. Our services are professional and affordable!