CMS RAC Base Line Audit Service FAQs
Q. What is the CMS RAC Audit and how does it affect me?
A. Medicare has contracted for 2009 and beyond to audit every provider in the nation and Puerto Rico who files with Medicare. It is expected to be fully in place by 2010 in all 50 states and Puerto Rico on a permanent basis. The purpose is to identify incorrectly billed claims that are overcharging Medicare. Based on findings, if compliance to Medicare billing rules is not up to standard, penalties may be assessed including fines and in severe cases, the loss of Medicare billing privileges.
Q. What is benefit of doing a Base Line Audit the?
A. The Base Line Audit will determine a provider's compliance with the CMS rules at the time of the audit. The Base Line Audit will prepare the physician for any internal changes to documentation or coding he/she may need to make.
Q. Can you help me understand the motivation for why a physician would want a third party to conduct this audit - why not wait for Medicare to do the audit - with the many physicians to audit, won't it take a long time to reach everyone.
A. Medicare will not provide any guidance to the physician or provider of care outside of giving them written guidelines. Our experience has shown that 95% of the providers won’t take the time to review. The RAC companies or contracts are paid on a contingency based fee, so they have every incentive to find incorrectly paid claims which is directly tied to the documentation on the record.
Q. Why pay someone to do the audit - will Medicare charge the physician for the audits if Medicare has to perform it?
A. Medicare will not provide any guidance to the physician or provider of care outside of giving them written guidelines. By performing a Base Line Audit the provider receives a Third Party Analysis of findings and recommendations and needed corrective action.
Q. How often should the audit be redone if it is a clean audit - when Medicare comes to perform the audit, how recent does the base line RAC audit have to be?
A. Yearly. We recommend the Base Line Audit be performed at with Dates of Services (DOS) anywhere from August 2008 to Dec 2008
Q. If a physician has this Base Line RAC audit certificate, will they still be subject to an additional audit from Medicare?
A. They will receive a report that has a Certified Coding Auditors report. This does not prevent the RAC auditor from performing their own government sponsored audit.
Q. Where can I find additional information on the RAC Audits?
A. An comprehensive explanation of the RAC program can be found at the following website: http://www.cms.hhs.gov/rac/ Other sources can be found by using your search engine.
Q. What material and hardware are required to participate in this program?
A. Access to a fax machine to send the medical records to the auditors. Email address to receive the auditors report for the provider. We can also provide onsite service for Southern California and parts of Georgia
Q. RAC audits are not scheduled for my state until later in the year; do I wait to start the process?
A. The purpose of the Base Line Audit is to prepare the physician for any internal changes to either documentation or coding he/she may need to make. Our role is to identify areas of non-compliance.
Q. How does your audit service work?
A. Once we receive payment, we will provide you with a list of the 5 office visit codes we pull files from. Your office staff can fax the information requested to our secure HIPAA compliant fax line. Our auditors will analyze the files and generate a report within approximately 1 week. We will then contact you and set a time to go over the report (via video conference) with you and consult with you as to any corrections that may need to be made. We can also provide onsite service for Southern California and parts of Georgia
