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It is no secret that payers - including
Medicare, private insurance companies and HMOs - have significantly
increased their oversight of physician practices' medical records
in an effort to identify improper payment and fight fraud and
abuse. The Centers for Medicare and Medicaid Services (CMS) have
used Recovery Audit Contractors (RACs) since 2005 to look at
services performed by the provider and determine if any over- or
under-payment has occurred. RACs are now a permanent, nationwide
program. While the chances of a practice undergoing an audit were
once slim, it is now a virtual certainty that every practice will
undergo an audit at some point. How well you and your practice
fare during an audit depends on your readiness to respond to a
request from one of the RACs. This article will help you to manage
the audit process and decide what to do in the event that over- or
under-payments are found. more...
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