Internal recovery audits can help small practices avoid fraud and abuse

The owners of small practices looking to avoid duplicate payments and other mistakes that constitute Medicare and Medicaid fraud and abuse should pay careful attention to certain high-risk areas, according to Chiropractic Economics.

Common infractions include upcoding (billing for a more expensive service than the one provided), submitting claims for services that weren't carried out or were unnecessary, double-billing, charging for services that aren't covered under programs and "unbundling," which is the process of charging for separate components that are reimbursed at a special rate when performed together.

Practices that are put under investigation can take several steps to identify and correct irregularities, including carrying out internal recovery audits. If fraudulent activity is discovered, it's important not to try to cover it up. Rather, changes should be documented alongside the original records and a note should be included explaining why they were necessary.

McKnight's notes that once a recovery audit contractor demand letter is received, healthcare facilities have 30 days to make payments before interest begins to accrue. The schedule can be tight, but taking preemptive actions such as conducting internal audits and designating an RAC coordinator to serve as a liaison can help prepare the practice.  

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