Recovery Audit Contractors: 5 RAC Findings That Could Be Troubling for Your Practice

Why This Topic Matters

The article helps practices identify high-risk reimbursement and documentation areas that may trigger audit scrutiny. It is useful for reducing claim errors and for understanding the kinds of billing issues Medicare has flagged in recent MLN Matters guidance.

Article Sections

1. RAC Issue 1: Place of Service Coding

   Discusses Medicare audit attention on place of service reporting and the settings involved in the issue. It also references related MLN Matters guidance.

2. RAC Issue 2: Duplicate Billing

   Covers duplicate claim patterns identified by RACs and the related Medicare overpayment concern. It also notes a brief reference to modifier use.

3. RAC Issue 3: E/M Codes With Pulmonary Diagnostic Services

   Reviews audit findings involving evaluation and management claims billed with pulmonary diagnostic services on the same date. It references related Medicare guidance and modifier use.

4. RAC Issue 4: Misuse of Add-on Codes

   Summarizes audit concerns involving add-on code billing and the absence of associated primary services. It points to the Medicare articles discussing these findings.

5. RAC Issue 5: Inappropriate Co-Surgeon Billing

   Describes RAC scrutiny of co-surgeon claims and the related Medicare billing concerns. It also references the associated MLN Matters article.