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TIP OF THE WEEK FOR PHYSICIANS FACING RAC OR MEDICAL AUDITS: VERIFY AUDIT FINDINGS

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 EIGHT FOR PHYSICIANS FACING RAC OR MEDICAL AUDITS:  VERIFY AUDIT FINDINGS 

Audit findings are often erroneous.  In fact, almost 45% of all appealed RAC contractors’ findings of alleged overpayments are overturned at the third level of appeal (the ALJ level).  Therefore, physicians should never assume that an auditor’s findings are accurate.  Rather, they should verify the substance of any findings - for example whether a particular code was billed correctly, whether a patient’s diagnosis supported a particular procedure, or whether a required pre-authorization was obtained.  They should also check the auditor’s math. When faced with a demand for repayment, physicians often believe that it is easier to just pay the amount demanded.  Although that may save time in the short-run, physicians taking that path not only pay more than is legitimately owed, but also may be subject to continued demands for re-payment for the same reason in the future.   Therefore, if a physician disagrees with the auditor’s findings based on this verification process, he or she should strongly consider filing an appeal.