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Tip of the Week for Physicians Facing RAC or Medical Audits: Determine on Whose Behalf an Audit is Being Conducted and the Scope of the Audit Before Submitting Any Documents

 

 

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 FOUR FOR PHYSICIANS FACING RAC OR MEDICAL AUDITS:  DETERMINE ON WHOSE BEHALF AN AUDIT IS BEING CONDUCTED AND THE SCOPE OF THE AUDIT BEFORE SUBMITTING ANY DOCUMENTS.

 Third party payers frequently contract with outside vendors to review medical records and to conduct audits.  Unfortunately, these companies do not always identify the payer on whose behalf they are working or the type and scope of the audit – critical information which physicians have the right to know.  If either the name of the payer or the type and scope of the audit are not readily apparent from a communication requesting medical records or initiating an audit, physicians should ask and should document the answers.  Such information is essential not only for physicians to know what type of audit they are facing but also to confirm that the entity seeking access to the records is legally authorized to access them under HIPAA or any more stringent state law.