Independent RAC Base Line Audit
Your practice is your life, it is your business. The lifeline of that business is your cash-flow. More than likely your cash-flow is dependent on insurance payments. If you accept insurance payments, Medicare is quite possibly the largest payer you have. For some medical professionals it can represent 75% or more of their total insurance payments.

The Medicare RAC audits have begun, and will continue on an ongoing basis. Have you run a test on your practice and diagnosed any errors in compliance?
By now you are probably aware of the Medicare RAC audits. A pilot program was initially done in 3 states, California, Florida and New York. The focus was strictly on hospitals in that pilot program with the exception of Florida, where 2% of the audits were also on physicians. The test was deemed a success as $900 million in overpayments by Medicare were returned to the US Treasury. Congress mandated going forward that the RAC audit be rolled out to all 50 states and Puerto Rico no later than January of 2010. All providers who accept Medicare payments are to be audited. It is not a matter of “if” you will be contacted, but “when” will you be contacted?
If you do not have a compliance plan in place, now is the time to prepare one – if you do have a compliance plan in place, now is a good time to have it reviewed.
The Medicare RAC auditors are paid on a contingency basis. What this means is they are compensated to find errors. You do have the right to appeal their findings, but anyone who has gone through the appeals process with Medicare knows how frustrating that can be. The auditors are looking at your coding and documentation, and checking for medical necessity. If you don’t know or aren’t sure what they want to see, you could be leaving a lot to chance. What you know is medical necessity for your patient could be interpreted differently by the RAC’s if your documentation isn’t what they want to see. What’s more, if your compliance is found to be below standard, Medicare will be back every 45 days with requests for more charts and documentation until standards are met. Not only is this a headache for you and your staff, but it can be quite costly as well.
A third-party audit review by an experienced firm prior to the RAC visit can save you thousands – and pay for itself several times over.
Just like you may order an x-ray or other test to see what is really going on with your patient, there are tests to see what is really going on with your practice and your cash-flow. Even if you have your own internal audit process in place ( and it is a good idea to have ), an independent third-party review can give you a base idea of where you are at and where you need to be with your compliance. The sooner you do this, the better. Any compliance errors you can catch and eliminate in advance of the RAC visit could add up to thousands of dollars in repayments to Medicare you can avoid. What is more, we find that approximately 15% of providers also find coding or compliance errors in which they were underpaid and are able to file for reimbursement from Medicare.

Precise Profit Solutions has the experience and the knowledge to help educate and correct compliance errors as well as assist in putting a precise compliance plan in place.
As part of our third-party compliance audit, we do an assessment of a random selection of your patient charts. We are HIPAA compliant and sign a Business Associate Agreement with you. Our highly professional and experienced team of coders will then perform an audit. All of our coders have a minimum of 4 years experience and certification from AAPC or AHIMA. Our team of coders also has specialty coding experience, so whether your specialty is cardiology, internal medicine, oncology, or another, your audit will be assigned to a coder who is familiar with the needs of your billing and documentation. Once the audit passes the first level of review it is then assigned to a second level for quality control. The coders at this level average 10 years experience and meet our high standards for excellence in review. Not only are the coders who perform the audit highly experienced, but they also have extensive practice in performing audits for government programs. The management team sat in on the initial RAC tests and knows what the RAC’s are looking for.
This experience is so valuable and prized that the medical corps of the US Army has contracted our team to audit their documentation.
Once the audit is complete, usually within 1 week, you will be presented with a confidential, comprehensive report detailing the findings along with recommendations. The report will be covered in a one-on-one session with you which normally last then an hour. Further educational webinars with a live instructor are also available for you and your staff if you wish. Courses are available during lunch hours, after hours, evenings and weekends. You will find that we are competitive and reasonable. The value that we bring to your practice will pay for itself with the peace of mind in knowing where you stand as well as the potential for thousands of dollars that your practice can keep and not pay back to Medicare.

For more information or to learn how to get started contact us here.

We appreciate the opportunity to diagnose your practice and assist you in your compliance. Having a bad review by the RAC audit is not pleasant. We look forward to being a resource to you in making sure that doesn’t happen.

You can find more information about how our audit works on our FAQ page here

For more information on the RAC program, you can visit the CMS site here