2. Recovery Audit Contractors (RAC)
• Inpatient Care
• Outpatient Care
• Clinics/Ambulatory Surgery
• Home Health
• Nursing Homes
3. What they look for:
• Documentation and coding inconsistency
• Overpayments made to Providers
• Clear documentation to support the medical
necessity of the services being provided
4. AuditGuard is a RAC Pre-Audit Review
• An independent assessment to identify areas
of non-compliance
• Identifies improper coding and billing that is
based on the medical records
5.
6. How AuditGuard Works
1. We pull and submit 50 charts for review
2. Certified Coder reviews documentation and
coding
3. Audit report is provided and reviewed with
you and your staff
AuditGuard
7. Why You Need AuditGuard
• Offer corrective actions required for
compliance
• Implement changes to stay in compliance
• Offer continuing education programs that
ensure the Provider is meeting
documentation compliance
8. 1. AuditGuard can receive any
document type: electronic,
paper or scanned image
Secured Transport
Secured Transport
2. When documentation arrives,
it’s separated and distributed
into different coding teams
3. Certified Coder analyzes
each chart
4. AuditGuard provides you a
Detailed Report
5.We present the results
to you and your staff
To ensure Providers are compliant and avoid legal action should they be chosen for one of these audits, we recommend a pre-audit be conducted, AuditGuard.
Recovery Audit Contractors (RAC)
Beginning in March 2009, for private firms were
contracted to perform medical records and billing audits.
Audits are conducted on providers in all 50 states for the following services:
Inpatient Care
Outpatient Care (Clinics/Ambulatory Surgery)
Home Health
Nursing Homes
The auditors review 50 historical claims and medical records (claims paid prior to 10/1/2007.) The goal is to recoup the money from overpaid claims, $1 billion in overpayments has been identified in California, New York and Florida hospitals in one year already.
The medical record must match the codes submitted for payment; Evaluation & Management (office visit), Diagnosis, Injections, Supplies, Medical Necessity. The record must clearly state the need for all services provided or prescribed.
If Providers bill Fee-for-Service Medicare,
Medicaid or Commercial Insurance programs,
They will be subject to an audit.
What they look for:
Documentation and coding inconsistency
Overpayments made to Providers
Clear documentation to support the medical necessity of the services being provided
AuditGuard is a RAC Pre-Audit Review
An independent assessment to identify areas of non-compliance
Identifies improper coding and billing that is based on the medical records
Recommended by Office of the Inspector General- have a 3rd party Independent coding audit on the medical charts
1. Licensee works with Provider to pull and summit 50 charts for review
2. Certified coder reviews documentation and coding
3. Audit report is provided to the Licensee and Provider
4. AuditGuard representative, Licensee and Provider review the Audit report via a web meeting
5. Licensee provides recommendation for improvement
Pull List is based on Productivity report during a 60 day period and percentage of office and hospital visit charges.
Certified Coders all have a minimum of 3 years of experience
Audit report details the chart information and summary report of any necessary actions that are required by the physician to become and remain compliant.
Value that you bring a Provider:
Offer corrective actions required for compliance
Implement changes to stay in compliance
Offer continuing education programs that ensure the Provider is meeting documentation compliance
Become the “one stop shop” for the medical practice in protecting against government and commercial insurance take-backs.
