Be Proactive in Preparing for Audits

The Medicare Recovery Audit Contractor (RAC) program now in full-swing in all 50 states is part of the Medicare Integrity Program that guards against Medicare fraud, waste, and abuse.

All practices that submit claims to government programs are likely at some point to experience a RAC audit. If you have not yet prepared for a possible audit, now is the time to get ready and have a plan in place.

Consider having an elective coding and documentation (C&D) audit. C&D audits verify that you and your staff are using correct coding techniques, ensure medical necessity of the services provided. This can be essential to establishing and maintaining compliance within a practice.

Consider having a certified professional medical auditor (CPMA) review your medical records. CPMAs have advanced training and knowledge in the following areas:

  • Compliance and regulatory guidelines,
  • Coding concepts,
  • Scope and statistical sampling methodologies,
  • Medical record auditing and abstraction,
  • Quality assurance and risk analysis,
  • Communication of results and findings, and
  • The medical record.

CPMAs not only review documentation to determine accurate coding techniques but also identify any red flags in documentation that might place your practice at risk of a third-party audit.

TMA can help. Contact TMA’s certified professional auditor, Heather Bettridge, at (800) 523-8766, or email practice.consulting[at]texmed[dot]org for more information about coding and documentation services, including some that offer continuing medical education credits.

Published Sept. 26, 2011


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Last Updated On

June 03, 2016

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