When a recovery audit contractor (RAC) decides to audit your practice, you must cooperate, or you can be excluded from Medicare or cut off from reimbursement. It’s also important not to panic. As long as you have a RAC preparation strategy, your audit should go smoothly.
Get ready for recovery audit contractors with these seven time-tested tips.
1. Stay Calm
Even though it may not feel like it when you get an audit notice, you can get through your audit successfully, so stay calm if you want to be in the right headspace to prepare properly. An audit isn’t the end of the world—in fact, almost all providers get audited at some point. What can set you apart from others is your level head and your ability to prepare thoroughly before your deadlines arrive.
2. Read the Audit Notification Letter Carefully
One reason it’s important to stay calm is that you can carefully and methodically read the audit notification letter so you know exactly what they want, what the deadlines are, and how they’re asking you to submit your records. You must follow those instructions to the letter if you want your audit response to be successful.
3. Make Copies of Everything You Send the Auditor
Every document you send the auditors—from emails and cover letters to vast reams of medical records—should be copied and maintained in your files so you have a record of what you submitted. These need not be paper copies —they can be electronic, as long as you have them on hand.
4. Evaluate Whether You Should Submit More
Suppose a RAC auditor asks you to submit a progress note for a certain date of service, but you know there are other records related to that note which will be important for the auditor to see if they want to assess medical necessity. In cases like that, consider sending more records than the RAC requests to show the full picture of how and why your clinician decided to perform certain services.
5. Internally Review Records
Before you submit your records to the RAC auditor, review them internally. You should take a look at the records and make your own assessment of whether the RAC is likely to find anything problematic. You may want to engage a lawyer or consultant at this point if you feel like you see results that put you at risk.
6. Found a Problem? Consider Self-Disclosure
If your review does find an issue in your records that indicates you billed improperly, you should first let your staff know about it. This way, you can stop the bleeding by educating your staff on how to correct this type of mistake going forward so you don’t continue to make the same errors.
And if you discover that you billed in error and it resulted in an overpayment, you’ll need to pay that money back to the government. Practices that participate in the Medicare Program have an obligation to return overpayments and participate in the self-disclosure process, so make sure you do everything to the letter of the law.
7. Be Ready to Check RAC Findings for Errors
When you get the RAC’s findings back, you’ll need to go through them line by line to ensure they didn’t make any errors. Perhaps they didn’t read the whole medical record, or maybe they’re using 2023 guidelines on codes you reported in 2020. Be prepared to compare their findings against yours, and if you see something they did wrong, be ready to point it out.
Audits by the recovery audit contractors may strike fear across your practice, but they don’t have to. Let healthcare attorney Jody Erdfarb, Esq. help you master RAC audits. During her 60-minute online training session, Stop RAC Auditors From Taking Back Your Medicare Money, Jody will help you hang on to your Medicare pay.
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