General Category > General Questions

RAC Audits (Automated Demands and requests)

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PMRNC:

--- Quote ---What compliance program?  Something on your website?  Or something you are just offering your providers?
--- End quote ---

Meaning the compliance plan I have in place for my business. All billing company's should have one. It's your road map which tells you what to do, mine of course is taylored for my business but based on recommendations by OIG.

The word "AUDIT" whether referring to RAC's or not.. is something to take very seriously. I would simply call the carrier(s) and just ask them. Did they send a letter?

DMK:
Last July all Northern California Chiropractors had approximately 50% of their claims audited.  Now I usually get 1 per claim batch.  The ADR is easy to fill out, and I can only offer my personal experience.

Send transcribed Tx notes (handwritten ones seem to get denied stating they were "illegible"), be sure the doctor SIGNS the notes.  Send any reports you have to verify the diagnosis.

I get 90% of my audited claims paid.  The ones they don't pay I usually figure out what I did wrong, or what was missing.

Good luck!

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