RAC AUDITS: RAC Contractors List 7 Audit Issues on Their Radar Screens

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Note:  The following article synopsis was NOT provided by AAPC. It was created by Find-A-Code/innoviHealth.

Article Overview

This article summarizes the initial audit topics announced by two Recovery Audit Contractors and explains the broader CMS context around audit review areas, refund reporting, and self-audit caution. It is aimed at coding, billing, compliance, and revenue cycle professionals who need to track RAC activity and understand which kinds of claims may draw review.

Why This Topic Matters

Understanding early RAC focus areas helps practices prioritize internal claim reviews, monitor contractor updates, and respond appropriately when potential payment issues are discovered.

What You Will Learn

  • Which broad claim categories were identified as early RAC review areas
  • How CMS contractor review postings relate to audit readiness
  • Why retrospective self-audits can create compliance follow-up considerations
  • What the article says about reporting improper payments and refunds

Who Should Read This

  • Medical coders
  • Billing staff
  • Compliance professionals
  • Revenue cycle managers
  • Healthcare administrators
  • Physician practice managers

Codes Discussed

  • CPT: 36430
  • CPT: 36455
  • CPT: 96360
  • CPT: 90760
  • CPT: 31625
  • CPT: 31628
  • HCPCS Level II: J2505

Code Ranges Discussed

  • CPT: 36430-36455
  • CPT: 31625-31628

Modifiers Discussed

  • CPT: KX
  • CPT: 59

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