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Tip of the Week For Physicians Facing RAC or Medical Audits: Ensure that Coding and Billing Practices Comply With Coding Rules and Relevant Medical Policies Before an Audit Occurs

 

    Recovery Audit Contractor (RAC) and private payer audits can be burdensome to physician practices. However, there are several things physicians can do to protect themselves before and during the audit process. Therefore, WhatleyKallas has compiled a "top ten" list of tips for physician practices facing RAC or other medical audits. We are highlighting one of these tips every week.  Click here for a link to the entire top ten list.

 

            TIP TWO FOR PHYSICIANS FACING RAC OR MEDICAL AUDITS:  ENSURE THAT CODING AND BILLING PRACTICES COMPLY WITH CODING RULES AND RELEVANT MEDICAL POLICIES BEFORE AN AUDIT OCCURS.

 

Physicians should regularly conduct random audits of their coding and billing practices to ensure that they comply with CPT and other coding rules and the relevant medical policies of the payers to whom they submit claims.  The mere fact that a physician’s utilization of a particular code is out-of-line with his or her specialty does not mean that he or she is coding inappropriately.  It may simply reflect that particular physician’s patient mix or subspecialty.  Nonetheless, it is incumbent on physicians to ensure that their coding and billing practices are compliant.  In addition, payers are increasingly performing pre-payment audits.  Although pre-payment reviews can be burdensome, physicians can use them to ensure that their coding and billing practices comply with a payer’s rules and medical policies, and, occasionally, to challenge and potentially correct a payer’s application of CPT.