decisionhealth Newsletters, Coder Pink Sheets - 2009 Issue 6 (June)
RACs get rolling: Expect to see audit letters shortly
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Article Overview
This article explains the early rollout of Medicare’s Recovery Audit Contractor program and why it matters for physician practices and facilities. It covers the general structure of the program, the kinds of claims issues being reviewed, the documentation burden practices may face, and the broad response and appeal timelines associated with audit letters. The piece is most relevant to billing staff, compliance teams, coders, and clinicians who manage Medicare claims and audit response workflows.
Why This Topic Matters
The article helps readers understand an important Medicare audit initiative that can affect claim payment, medical record requests, and repayment exposure. It is useful for practices trying to prepare internal processes and monitor the types of services and claim patterns that may draw review.
Article Sections
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What they are
Introduces the program structure and the general role of the contractors involved. It also describes the broad types of review used in the audit process.
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What they'll be looking for
Summarizes the categories of claims issues and coverage concerns that may be reviewed. It also notes the types of external audit findings being used as reference points.
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E/M services a target
Focuses on evaluation and management claims as a review area and discusses the broader concern about audit burden for these services. It also mentions the related professional discussion around whether such reviews should occur.
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How to respond when the demand letters arrive
Outlines the general response window, repayment options, and appeal timing discussed in the article. It also notes the availability of extended payment arrangements.
What You Will Learn
- How the Medicare audit contractor program is structured at a high level
- What kinds of claims and coverage issues the article says may be reviewed
- What kinds of documentation requests practices may receive
- What broad response and appeal timelines are described for repayment notices
- Why evaluation and management services are discussed as a likely focus area
Who Should Read This
- Physician practices
- Medical coders
- Billing staff
- Compliance officers
- Practice managers
- Healthcare attorneys
Codes Discussed
Code Ranges Discussed
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