There is a perfect storm brewing. There are Recovery Audit Contractors (RACs) in every state in the U.S. now along with a renewed focus on healthcare fraud by many institutions and by the public in general. The stage is set so be prepared!

1. Do Your Program and Requirement Homework
   • Know the integrity programs and claim review audit requirements inside and out.
   • By knowing what’s in the programs and what the requirements are you can find out a time period for when records can be reviewed, whether or not an auditor is allowed on site and if an audit is even allowed in the first place.
2. Get Help from Professionals
• Make sure to get an external, outside consultant to look at your billing, coding, and documentation to see what you are doing right, what can be done better, and needs to be changed. This will greatly lower your risk for an audit.
3. Go Deep Inside Your Process
• Make certain that your front-end process for obtaining and verifying insurance is very thorough and well executed.
• Be proactive today to prevent “reacting” to a potential audit.
• Make the changes and give adequate time to make sure your providers are educated about the new processes.
4. You need an Audit CZAR
• You need just one point of contact for an audit that is happening or MAY happen.
• This person should be a Full-time employee with a clinical or administrative position.
5. Don’t Jump the Gun and Send Information Out Too Quickly
• Make sure to do your own audit to see what problems you may have before sending out a request for records.
• After the self-audit, provide a cover letter with the request for records explaining your process as to what you bill and why you bill it. Show sturdy justifications.
• Help the auditor to the information needed in the easiest way possible. Don’t make them hunt for it. Auditors find things they weren’t originally looking for when they “hunt”.
6. Document All Dealings With Auditors
• Track all transactions with the auditor and make copies of everything you send along with a shipping receipt. Don’t get in a “he said – she said” argument about missing submissions. Be ready to back it up. Just like the IRS, if you don’t have the receipts, you don’t get the deduction.