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:
- Are the services and supplies proper and needed for diagnosis and treatment of the diagnosis?
- Do any charges appear to be “unbundled”?
- Does the procedure code correctly describe the service provided?
- Are the HCPCS and/or CPT codes updated and correct?
- Are the E and M codes used appropriate and does the documentation support their use?
- Are the modifiers used properly?
- Were the correct and updated ICD-9 or ICD-10 CM codes linked to the diagnoses and procedure code(s)?
- Is the place of service appropriate?
- Are there duplicate services rendered on the same date?
- Does the documentation support the services billed?
- Is the medical record clearly written, accurate and complete?
- Is there any evidence of “intentional deception”?
- Did the billing provider actually render the service?
- Were all billed services actually rendered?