RAC audits are now permanent and prevalent across every state and will begin to initiate reviews this year. It is a great time to make sure that your organization is compliant with all applicable regulations and billing/coding issues. A recent study found that at the average healthcare organization only 58% of services were properly coded, while 28% were over-coded and 15% were under-coded. If your organization is within this average it could spell trouble, and now is the time to look for a firm who is experienced with compliance in healthcare to assist you in readiness.
Here are our top 5 hints for making sure that your organization would be RAC Audit Ready
1. Internal Audit- conduct an internal audit of your organization to show that you are committed to the effort of submitting complete and accurate claims to payer, and identify any problems early before someone else does
2. Independent Audit- have an independent company conduct an audit of your organization to make sure that external findings support your own audit findings
3. EMR Coding/Documentation Review- Evaluate the impact that your EMR system is having on your coding and documentation
4. Know your Numbers- organizations are most often targeted for audit based on utilization rates, prescribing practices, and billing/coding practices. Make sure that you know the numbers of your organization in order to evaluate your risk early
5. Hire a Dedicated Compliance Officer- we can not stress enough how important it can be to have an individual who is certified in healthcare compliance on staff. A compliance officer can work with senior members of your organization to ensure that you are prepared for an unannounced audit or investigation.
Compliance in healthcare can be a potential minefield for individuals and organizations, but with a little bit of preparation and a strong focus on compliance, coding, billing, and documentation you can be sure that you are prepared.