Recovery audit contractors (RACs) can retroactively deny your claims for a number
of reasons however one that can effortlessly be remedied is lack of medical documentation on your practices part.
If a recovery audit contractor requests your medical documentation and you do not send it or you submit incomplete or illegible records, your payments may just be denied. To add to it, money that your MAC already sent to you can be got back to the carrier in cases of nonexistent or unfinished documentation.
Recently the topic of incomplete documentation was identified by CMS as a high dollar improper payment vulnerability.
Medical coders should be catching insufficient documentation before a claim leaves the office; however in some cases it is caught by RACs on the back end, after a claim has already been reimbursed.
If you know you are missing documentation, you should not bill for the service in the first instance or you may have to reimburse that money down the road.
Recovery Audit Contractors must be crystal clear
Your practice is not the only party in the RAC-provider relationship that has to play by the rules. The RACs need to stay within the following guidelines when requesting documentation from medical providers.
The RAC must point to the deadline by which you need to submit your medical records
The RAC must contact you one additional time prior to denying your service based on lack of documentation
The RAC must point to the status of the providers additional documentation request on its claim status website.
The RAC needs to maintain a provider web portal where providers can customize their address and find the right point of contact.
The RAC must post all accepted issues under review on its website.