Too often Ambulatory Surgical Centers are ill prepared for an RAC audit. It is in the ASC’s best interest to have an ongoing process that prepares your center for possible audits. In order to successfully avoid an RAC audit your ASC needs to have detailed and accurate documentation. It is imperative that your center is accurately translating your medical records into standard medical coding. There are 3 steps your ASC should take to achieve accurate documentation and medical coding.
- Employ Medical Coding Professionals- The work of your medical coders will determine the likelihood of an RAC audit. Whether your ASC is hiring your own medical coders or if you are using an outside source, make sure they are extremely well trained. When an ASC is being audited there are 4 common problems centers have that result in poor findings:
- Defectively trained staff
- Staff lacks the time to medical code thoroughly
- Medical coders misinterpret rules
- ASC’s have frequent rotations of new staff
To avoid these common problems it might be in your ASC’s best interest to higher an outside source for medical coding.
- Conduct Internal Audits- One of the best ways to avoid an RAC audit is to practice internal audits. This should be done on an annual basis. An internal audit needs to be done thoroughly and may require your center to hire a contractor to review your medical coding and billing processes. Even though this is an extra expense, it may be the step that saves your ASC from an RAC audit.
- Review Your EMR Vendor-The electric medical record system your ASC is using may affect your medical coding and billing. Some EMR systems may be up coding billing through automatically generated detailed patient histories. This may occur when employees copy and paste the patient’s previous examination findings into their current findings. It might also happen when common templates are filled in to suggest a more thorough examination. Make sure to review your EMR program to decide if it contains the programming that automatically up codes billing based on documentation.
An RAC audit can impact the financial stability of your ASC greatly. It is important to proactively prepare for audits in order to avoid them altogether.