Audit-proof your practice: Be prepared for RACs and MICs

Why This Topic Matters

Audit activity can create financial, administrative, and compliance pressure for practices that bill Medicare or Medicaid. Understanding the general scope of these programs and the kinds of operational safeguards discussed can help organizations assess whether the full article is relevant to their audit-preparedness efforts.

Article Sections

1. RACs and MICs come out to play

   Introduces the Medicare and Medicaid audit programs discussed in the article and explains why they matter to physician practices. It also summarizes the broad categories of payment and documentation issues associated with audit findings.

2. Steps and methods for audit preparation

   Covers CMS-suggested preparation activities and the use of technology to support internal review, response workflows, and ongoing compliance efforts. It also outlines how practices may use audit-related information to identify patterns and improve operations.

3. Before:

   Describes pre-audit planning activities and the role of software in identifying areas of concern and supporting staff education. The section focuses on practice-level readiness rather than specific coding outcomes.

4. During:

   Addresses the operational burden of working with auditors and the way systems can help streamline records retrieval, reporting, and tracking. The emphasis is on workflow support during audit activity.

5. After:

   Discusses post-audit review and using audit results to inform education, training, and process improvement. It emphasizes ongoing compliance and monitoring.

6. Don't wait for RACs to knock on the front door

   Concludes with a general warning about increasing payment review pressure and the value of preparedness for practices that submit Medicare and Medicaid claims. It highlights the importance of sustainable compliance systems.