If you’re a physician and the RAC process has remained somewhat obscure you’re not alone. Across this country the rules have been changing with Affordable Health Care and to steal a line from Jerry McGuire it’s about “Show Me the Money”! With over 5 billion in recovery to this point by RAC under the auspices of Fraud and Abuse it is unlikely that these audits will ever truly cease.
Among the numerous surprises that come from RAC is now Transmittal 534 which essentially says that regardless of the hospital bill the physician bill is now subject to review. So for the MD concerning themselves with patient care, what can be done?
1. The old standby has never been truer regarding documentation. If it isn’t documented it wasn’t done. To add to that documentation should tell the story of the admission, diagnostics, and reason for treatments.
2. Don’t overly rely on “canned documentation”. The OIG has their eye on this and the aggressive use of canned notes will likely mean trouble in the future.
3. Most importantly do independent audits using known CMS criteria.
In order to independently self-audit you’ll want to set a few criteria. These criteria will assist in the efficiency of your audit plan.
1. Randomly select claims to review. This allows for much of the same review as is seen in the real world where analytics aside many cases are simply randomly chosen.
2. Choose a percentage of claims based on previous losses. If you know you or your practice is losing based on a particular diagnostic, procedure, or other criteria than put a percentage of your focus on that item.
3. Capture data on your results. Audits are only as good as the data they generate. If you’re not submitting that data in a useable way to your practice than it has no real value.
4. Discuss and adjust. In our audit practice here at Medlinks our primary focus is to discuss and adjust. This has created the result at several sites where we have been able to eliminate audits.
To learn more about medical auditing visit www.medlinkscostcontainment.com and see how we can create zero denials for your group.
Medical Audit Minutes Presented by Medlinks™ is intended to quickly highlight “audit Issues” for the medical community. Medlinks Cost Containment, Inc. has been servicing the medical community since 1997 in the area of auditing and revenue cycle solutions.
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