What are RAC Audits?
RAC stands for “Recovery Audit Contractors.” These contractors are hired by the Centers for Medicare & Medicaid Services (CMS). Their purpose is to audit and recover dollars to put back into the Medicare Trust Fund. These contractors have a huge incentive as they are paid on contingency (what they recover) on a percentage basis, so you can be sure they will be aggressive in their audits. Any overpayments found by the RACs will need to be reimbursed to Medicare, which can collect their reimbursement from any future claims checks owed to you.
What does ICD-10 mean?
CMS has mandated that all medical billing be submitted with the new ICD-10 codes by October 2013. The new system will add an additional 150,000 new codes. Now, more than ever, accurate and quality documentation / transcription will drive the revenue cycle. The Medical Group Management Association (MGMA) conducted a survey that resulted in estimates of roughly $84,000 for the average small physician practice to upgrade to ICD-10. Large practices could be facing an implementation price tag in the neighborhood of $3 million dollars.
The RAC pilot began with three states in 2005 and in 2007 expanded to include three additional states. RACs corrected more than $1.03 billion of improper Medicare payments during the three-year demonstration period, resulting in more than $900 million in overpayments being returned to the Medicare Trust Fund. 8 percent were due to insufficient documentation and another 35 percent of the errors were connected to incorrect coding.
MDofficeManager VALUE ADDED
Improved Clinical Documentation – Legible, accurate and thorough documentation is more important to the continued financial health of a practice or facility than ever before.
Centralized Electronic Medical Records Online – Easy access to critical data and stored documents is critical to responding to RAC requests in a timely fashion. Our ability to do data mining will help practices and facilities be RAC ready.
More Accurate Coding – The documentation should support the level of service provided to justify medical necessity (one of the top ten targets of audits).
Physician documentation is the single – most important element of the medical record accounting for the facilities’ ability to submit appropriate claims, defend medical necessity monitor performance and substantiate quality of care, etc.
MDofficeManager Physician Productivity Analysis – Research shows that a physician spends 4.5 minutes per patient documenting with a point and click system. Our transcription services takes about 1.5 minutes per patient. That saves 3 minutes per patient.
