Best Practices: Audit-Ready Tips From the Horse's Mouth

Why This Topic Matters

Audit preparedness can affect claim integrity, response timeliness, and an organization’s ability to identify and correct compliance issues before they lead to denials or payment recovery.

Article Sections

1. Communicating with your RAC is key

   An overview of the article’s emphasis on working with Recovery Auditors during review activity. It frames the practical preparation topics covered in the rest of the piece.

2. Know Where Previous Improper Payments Have Been Found

   Discusses looking at prior audit and program reports to understand where improper payment findings have occurred. References CMS-related sources used for identifying recurring issue areas.

3. Know if You are Submitting Claims With Improper Payments

   Covers internal assessment and compliance monitoring concepts. It also mentions follow-up steps related to corrective action and appeals.

4. Prepare to Respond to Recovery Auditors Medical Record Requests

   Focuses on the operational side of handling medical record requests and keeping contact information current. It also addresses checking the status of requested records through Recovery Audit Program channels.

5. Learn From Past Experiences

   Notes the value of tracking denied claims and reviewing patterns over time. The section is centered on using past audit outcomes to inform future compliance efforts.