If you are a Medicare and/or Medicaid provider, your practice will become a “red flag” for a RAC audit. Unfortunately, these are not one-time events. Once your practice has been audited, it will continue on an ongoing basis. As auditors increase their resources, the RAC audit process (along with other audit programs) will become permanent and progressively intense.
In addition to being a Medicare/Medicaid provider, many reimbursement audits are triggered by coding, billing, and utilization anomalies. Physician coding errors alone average 62% of all mistakes! You must change and improve the behaviors, coding and billing patterns, and skill sets of staff and providers to become a precise, fully compliant documenting, coding and billing team.
When audits do occur, you can attempt to protect yourself, however, your staff may not understand the best ways to shield you and your practice. Many practices turn to their lawyers, but this method can be extremely expensive. Not only will an audit often entail substantial legal fees, but also large consulting fees for shadow audits and the external professional advice that will need to be obtained during the process. Since RAC/MIC/MAC audits are conducted on an ongoing basis, retaining an attorney specifically for audit defense appears to be an unrealistic option.
Your best defense is to become a part of StenTel’s RAC Audit Program.