decisionhealth Newsletters, Part B News - 2012 Issue 1 (January)
Doctors use MAC policies to fight RAC denials
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Article Overview
This article discusses how physician practices can respond to Recovery Auditor Contractor (RAC) audits by relying on carrier and Medicare policy documentation. It focuses on compliance, audit tracking, claim review, timing of denials, and the importance of preserving payer guidance and involving clinicians when disputing audit findings. The piece is relevant for medical billers, coders, compliance staff, and practice managers who handle audit appeals and payment recovery issues.
Why This Topic Matters
RAC activity can create payment reversals based on audit findings that may not align with the policy in effect for the claim. Understanding how to document carrier guidance and respond quickly helps practices protect reimbursements and support appeals.
Article Sections
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Compliance
An overview of RAC audit activity and how it can create payment disputes for physician practices. The section introduces the article’s focus on Medicare policy, carrier guidance, and audit response.
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A learning opportunity for practices
Practical guidance on preparing for audits, preserving documentation, tracking denial activity, and involving clinicians in dispute resolution. The section presents general strategies for responding to RAC and other auditor actions.
What You Will Learn
- How RAC audits can affect physician claims and payment recovery
- Why carrier policy documentation matters in audit disputes
- How practices can organize internal responses to audit notices and denials
- Why the date of service and applicable policy period are important in audit review
- How clinicians may be involved in challenging audit findings
Who Should Read This
- Medical coders
- Medical billers
- Compliance staff
- Practice managers
- Physician office administrators
Codes Discussed
Modifiers Discussed
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