Md Audit Shield – Rac
Prepare for RAC Auditing!
The federal government has introduced the Recovery Audit Contract (RAC) program, a new oversight initiative aimed at identifying and eliminating fraudulent medical claims. Private auditing companies have been contracted to conduct audits of medical records and claims billing across all 50 states. These audits can target any provider billing fee-for-service Medicare, Medicaid, or commercial insurance programs, and will focus on three key indicators of fraud: 1) coding inconsistencies, 2) documentation supporting the medical necessity of services provided, and 3) discrepancies in overpayments or underpayments.
This new procedure is crucial for all medical practices. Should your practice’s claims and records be audited and any inconsistencies discovered, you will be obligated to repay not only the identified overpayments but also interest. Additionally, appeals have proven largely unsuccessful, and auditing companies will continue to audit your practice every 45 days until they find no further evidence of fraud. Reports indicate that the RAC program has already uncovered over $1 billion in overpayments in just a few states.
