The federal government has recently implemented the “Recovery Audit Contract (RAC),” a new control process intended to weed out the large volume of fraudulent medical claims. To accomplish this, the government hired private auditing companies to perform audits on medical records and claims billing in all 50 states. Audits may cover any provider who bills fee-for-service Medicare, Medicaid, or commercial insurance programs. The audits will check for evidence of fraud by examining three common indicators of fraud: 1) coding inconsistencies; 2) documentation to support the medical necessity of the services provided; and 3) overpayments or underpayments to providers.

This is a critical new procedure for all medical practices. If your practice’s claims & records are audited and any of the three inconsistencies are found, you will be required to pay back not only the overpayment but also interest. In addition, appeals have not been successful. And the auditing companies will continue to audit your practice every 45 days until they find no further evidence of fraud.

Reports estimate that the RAC program has already identified more than £1 billion in overpayments in just a few of the 50 states.

Why take a risk in your practice? Begin using our MD Audit Shield services to eliminate the chances of an audit proving inconsistencies in your billing. While nothing will keep the government from auditing your practice, our MD Audit Shield service will at least protect your practice in several ways. MD Audit Shield takes the following steps to ensure your compliance:

In addition, medical offices need to consider CodeMAXX, a new service that manages your medical coding in accordance with the national …Read more