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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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