Friday, May 8, 2015

14 Questions for RAC Self Audits

RAC Self-Auditing

Here are 14 simple questions that will give you peace of mind regarding your RAC self-audits.

Randomly select 10 Medicare patient records then apply these simple questions to each record: 
1.      Are the services and supplies proper and needed for diagnosis and treatment of the diagnosis?
2.      Do any charges appear to be “unbundled”?
3.      Does the procedure code correctly describe the service provided?
4.      Are the HCPCS and/or CPT codes updated and correct?
5.      Are the E and M codes used appropriate and does the documentation support their use?
6.      Are the modifiers used properly?
7.      Were the correct and updated ICD-9-CM codes linked to the diagnoses and procedure code(s)?
8.      Is the place of service appropriate?
9.      Are there duplicate services rendered on the same date?
10.  Does the documentation support the services billed?
11.  Is the medical record clearly written, accurate and complete?
12.  Is there any evidence of “intentional deception”?
13.  Did the billing provider actually render the service?

14.  Were all billed services actually rendered?