RAC Audit

RAC Audit Preparation Tips

The increase in audits has made them more of a rule than an exception.  Each year, approximately 9% of physicians undergo a RAC audit.  According to projections, within the next eleven years, every eligible physician will face a RAC audit.  Insurance companies and government agencies are using the audit to recover improper claims payments as the rising cost of healthcare is impacting their bottom lines like never before.

Paid on a contingency basis, Recovery Audit Contractor (RAC) auditors are generally very aggressive with their auditing.  If you are not prepared adequately, the audit can become an administrative nightmare for healthcare providers.  A failed audit will result in fines, legal fees and in the case of evidence of fraudulent billing – even a jail term.  A healthcare professional is trained to provide healthcare and anything that takes his attention away, impinges on both time and quality of the healthcare provided.  However, since the provider is being paid for the services, audits of billings made, become par for the course.

In order to avoid the stress and dread of these audits, healthcare providers need to prepare themselves – understanding the requirements, making sure that all relevant documents are in order and regularly reviewing their records to ensure that they meet the requirements.  Here are some tips to help healthcare providers to reduce the chances of an audit and prepare themselves for one in case it happens.

Review and monitor regularly
If errors are not known, they cannot be rectified.  It is imperative that there is a regular tracking and monitoring mechanism in place to review denied and / or rejected claims.  More often than not, there will be a pattern to these denials/rejections and being able to identify the cause will ensure corrective measures can be put in place.  Use historical data to analyze the areas of risk – who to audit is determined by RACs, using five main categories to compare a provider’s performance with respect to their peers.  It is also important to regularly review RAC updates, issues and news; in order to stay abreast of the regulations and requirements.

Training as an ongoing process
There is no such thing as fully trained – with the changing regulations and requirements, the last training undertaken is no longer enough.  Staff training on documentation requirements and coding practice is absolutely necessary to ensure that your records are in perfect order.  Similarly, training on audit requirements and process will ensure that there are no glitches or stress at the time of an audit.  Regular meetings with the concerned staff with discussions and information on error analysis, new requirements and any RAC updates will help in keeping your staff up to date and make undergoing an audit easier and smoother.

Ensure audit readiness

Preparation is more than half the job done – ensure that all your records are in place for any eventuality.  Make sure that all your records and documentation are up to date and filed for easy and quick access.  Starting to collect documents and records after receiving an audit request, more often than not ends up with missing records and documentation errors – remember, there are only 45 days available to respond to an audit request and submit all documents and records.  Put an internal process in place that deals with and streamlines all audit requests and requirements – from reviewing documentation to making sure that they are compliant and complete; from understanding the audit requirements to setting a timeline to meet the deadlines.

Take a proactive approach
Prevention is better than a cure – who knows this better than a healthcare provider.  Following the same principle, a proactive approach is far better than a reactive one.  It pays to ensure a year round readiness and constant compliance for RAC audit requirements along with all other healthcare regulations in force.  This reduces the stress and errors associated with audits and ensure better chances of receiving your just dues.

The MedConverge advantage
MedConverge offers complete and tailor made solutions to automate, streamline and integrate the audit preparations for your facility.  With our advanced capabilities, you can:

  • Save time, effort and costs
  • Increase efficiency on RAC audit collaboration across the enterprise
  • Speed up the response time to audit requests
  • Handle appeals efficiently and smoothly

For a proactive approach to your audit requirements, contact us for a baseline audit for your medical billing and coding.  For further details, contact us on

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