Audit Contractor Case Study

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Discuss how Relative Audit Contractor Can Impact A Physician Practice? Recovery Audit Contractors can impact a physician practice in several ways which can be both positive and negative depending on various factors, as we about to witness below. The fact that, these contractors are hired by Centers for Medicare & Medicaid Services to audit and recover dollars to put back into the Medicare Trust Fund, these have a huge incentive as they are paid on contingency, and percentage basis. Therefore, one can be sure that these will be aggressive in their audits. That is; any overpayments found by RACs will need to be reimbursed to Medicare, which can collect their reimbursement from any future claims checks owed to you. RAC audits will be able to…show more content…
Therefore, under this program, RACS were able to recover 95% of the claims they audited. With these RACs in place, would be a great impact on a physician practice for them to become even more careful when billing Medicare claims. Auditing a physician practice in advance can help identify improper billing and coding and take necessary corrective actions prior to the RAC audit. In doing this, helps the practice save time and money, as well as find areas they are being under reimbursed, such that, they can collect their amount when time is still…show more content…
For instance, they continue to report that, the demonstration project found that RAC audits resulted in sizeable amounts of overpayments collected from many providers. That is; they further notice that, data obtained from CMS show that RAC overpayments collected for FY 2010 were $75.4 million, increased to $797.4 million in FY 2011, and increased to $986.2 million in the first six months of FY 2012. According to the American Hospital Association RACTrac audit survey, notes that, the vast majority of these collections represent complex denials where hospitals are required to provide medical record documents in support of their billed claims. It still notes that, this study found out that, the RAC audit program collections are increasing significantly over time and as a result, these collections are having a significant negative impact on the profitability of U.S. hospitals, which in return can negatively impact a physician

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