decisionhealth Newsletters, Coder Pink Sheets - 2009 Issue 6 (June)
RAC audits: What every coder needs to know
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Article Overview
This article explains the Medicare RAC program and how it affects coding, billing, and audit response workflows. It outlines the broad categories of claims issues being reviewed, the limits on medical record requests, and the general timing for appeals and repayment options. The piece is aimed at coders, billing staff, and practice administrators who need to understand RAC audit exposure and preparation.
Why This Topic Matters
RAC audits can trigger repayment demands, record requests, and appeal deadlines that affect revenue cycle operations. Understanding the program helps practices prepare for documentation requests and respond within CMS timeframes.
Article Sections
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What they'll be looking for
A summary of the kinds of claims and payment issues CMS says are under review for RAC audit activity. The section also frames the audit environment for providers and practices.
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RAC audits mean increased paperwork
Limits on medical record requests are described by practice size, along with the time allowed to respond to a request for additional information.
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How to respond when the demand letters arrive
General response options and timing windows are outlined for providers who receive a RAC demand letter, including appeal and repayment paths.
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How to spot a RAC
Background on RAC contractors, how they are paid, where they operate, and the two broad review methods used in the program.
What You Will Learn
- What the RAC program is and why it matters to Medicare providers
- Which broad claim types are being reviewed in RAC audits
- How medical record request limits are structured by practice size
- What general response timelines apply after a RAC demand letter
- How RAC contractors conduct automated and complex reviews
Who Should Read This
- Medical coders
- Billing staff
- Revenue cycle professionals
- Practice administrators
- Compliance staff
- Physician offices
Modifiers Discussed
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