The federal government implemented the Recovery Audit Program, which is a program designed to identify overpayment and underpayment of medical claims and to correct it. To accomplish this, the government hired private auditing companies, called recovery audit contractors(RAC) to perform audits on medical records and claims billing in all 50 states. Audits may cover any provider who bills fee-for-service Medicare, Medicaid, or commercial insurance programs. The audits will check for evidence of improper payments by examining three common indicators:
- Coding inconsistencies
- Documentation to support the medical necessity of the services provided
- Overpayments or underpayments to providers
This is a critical procedure for all medical practices. If your practice's claims and records are audited and any of the three mentioned inconsistencies are found, you will be required to pay back both the overpayment and interest. In addition, appeals have not been successful. The auditing companies will continue to audit your practice every 45 days until they find no further evidence of improper payments.
Reports estimate that the RAC program has already identified more than $1 billion in overpayments in just a few of the 50 states.
Why take a risk in your practice? Begin using our medical audit services to eliminate the chances of an RAC 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:
- 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.
It is a great feeling to know that you are Medicare Compliant. Please contact us to be prepared and be compliant.