In order to cure this problem related to insurance claims, the government has developed a plan known as theMedicare RAC Audit to review the situation and fix any discrepancies in the claims made by medical providers. In a review made by the Centers for Medicare and Medicaid Services (CMS), it is noted that almost $1.03 billon has been recovered from improper billing payments. The range of services that will come under the radar of this act includes hospital inpatient and outpatient, physician, ambulance and laboratory, skilled nursing facility and durable medical equipment. There will be various Integrity Contractors to provide anti-fraud training to the staff members to different medical providers to prevent any kind of over or under payment prior to the commencement of the Medicaid Integrity Contractor audit.
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Integrated Medicare RAC Audit Process
This integrated program has two ways of functioning. In the automated review process of the Medicare RAC audit, the RAC auditors looks in the claims made by the hospital for services like durable medical equipment, ambulance and laboratory services, skilled nursing facility services etc., and they are authorized to look into any data after 2007. Once any kind of discrepancy is found with the data of any such provider, the representatives of the provider are allowed to have an open meeting with the RAC auditors. If they agree upon the claim, then they are given different options like paying through check or adjusting money from future payments as means of settling the amount that was overpaid/reimbursed to the provider. However if they biller/provider disagrees with the RAC officials then they have the option to file a complaint within 120 days of the finding.
Candidates who are interested in securing their future with a medical records and RAC audit career should be a medical or semi-medical practitioner. By the rule of the Law, it has been made mandatory that RAC should be comprised of staff members who are nurses, certified doctors, therapists and certified coders. The RAC are scheduled to receive a part of the under or overpayment that they manage to collect from the medical providers. By law, there has to be four RAC, each will be responsible for one fourth of the country. The RAC are very likely to affect common people if they happen to be subscribers of bill-fee-for service programs.
In view of the current circumstances, medical RAC audit career services have become a highly demanded job option for many students and professionals associated with the medical or the auditing profession. Hospitals and medical units are looking for candidates with a solid background in hospital billing and RAC audits. The person will be responsible for maintaining an accurate database of accounts about medical billing and transcription.
Good communication and interpersonal skills are very important for a RAC audit-coding career. Candidates applying for Medicare RAC audit career jobs should preferably have a bachelor’s degree as a Certified Coding Specialist (CCS) or as a Registered Health Information Technician (RHIT). Candidates with proper knowledge about various medical terminologies are expected to have an added advantage over other candidates applying for medical billing & transcription RAC audit services.
The RAC Act happens to be a very strict and has grave implications for the provider’s reputation if they are found to issue improper bills and claims. So in order to escape from such kinds of embarrassment, it is desirable that the provider himself identifies improper coding based upon the medical records of the patient. There are many audit firms that provide RAC audit services to companies, so that they can analyze their situation and be prepared for any impending dangers. Identifying areas needing corrective action or improvement, and implementing any changes to abide by the law, makes compliance easier for healthcare providers. In case the provider finds out about discrepancies in payment made and received, they can make a declaration to the RAC officials that can greatly help them in future proceedings. Getting the staff adequately informed about the RAC laws and cooperating with the RAC officials during the audit process eliminates many problems for either side.