Unfortunately, audits have become a way of life for medical practices. Compliance issues for providers should always be a priority. The talk is intended to provide a roadmap to assist providers in identifying risks that make them vulnerable to RAC (Recovery Audit Contractor) audits and to educate them on ways to prepare for and anticipate RAC audits.

RAC auditors are paid on a contingency basis calculated on the overpayment amounts they recover. The size of the overpayment can be significant if the RAC findings are extrapolated and the overpayment is calculated on that basis.

While the revenue cycle team works at getting claims paid, it also must focus on how to keep those payments from being recouped. The talk will cover common RAC audit findings, how the audit process works, and what steps to take in the event a RAC audit results in an overpayment letter. Finally, we’ll address preventative measures a practice can take to mitigate the risk of an audit.

What you’ll learn

• What is a RAC audit and how does the RAC select providers for audit?
• New CMS approved RAC audit topics
• Medical Reviewer Guidelines for coding and medical necessity reviews
• Common RAC audit findings
• The RAC audit documentation request (ADR) process and how to prepare a response to an ADR
• The consequences of missing the ADR deadline
• Strategies for contesting the extrapolation of the RAC calculation of the overpayment
• Next steps after an overpayment letter is received — how to evaluate your position and options available prior to an appeal
• The appeal process to RAC overpayment audit findings
• Preventative measures to avoid RAC audits