R.A.C. Audits
What is “The RAC”? The Recovery Audit Contractor is a federally mandated program designed to detect and correct improper past payments made on claims of health care services provided to Medicare beneficiaries. Since the start of the program in 2003, over one billion dollars of improper Medicare payments have been identified. The statistics show that over 96% of these payment represented over payments.
The Recovery Audit Contractors may examine your patient charts and attempt to identify improper payments that result from any of the following…
- Incorrect Payments – (based on lack of proper documentation of the chart notes)
- Non-Covered services – (including those considered reasonable and necessary)
- Incorrectly Coded Services
- Duplicate Services
THE TURNER GROUPSÂ Baseline Audit is offered to assist practices of all sizes prepare themselves for audits by the C.M.S. Recovery Audit Contractors as well as those from Medicaid and commercial payers. This multi-chart audit is designed to examine your current and past billing and coding practices to insure that you are complying with the CMS guidelines. Establishing a baseline and putting corrective measures in place now, may be your best defense for the upcoming RAC.
- We will perform a 50 chart random audit per physician.
- We will provide a detailed compliance summary on our findings with recommendations to bring your documentation into Medicare compliance.
- We identify areas of under payments and communicate this to you so proper coding can be utilized to optimize your reimbursement rates.
- We use Certified Coding Auditors
- Provide Evaluation and Management by Specialty
- Provide Documentation Compliance rules for all levels of service.
- Review for correct diagnosis coding.
- Coding expertise for all specialties.
- Determination of medical necessity.
