As the nation continues to recover from the COVID-19 pandemic, audits are back in full swing, and Recovery Audit Contractors (RACs), Unified Program Integrity Contractors (UPICs), and other auditors are busy reviewing claims on a post-payment basis. However, the pandemic has caused a staffing shortage, leaving many provider facilities scrambling to keep up with the increased workload. If you add to this an audit of 150 claims, it can lead to serious scuff-laying.
Preparing for audits has changed since the pandemic hit, and now that is a lot of work. Audits increase the amount of work when fewer staff members are available, making it essential to know the COVID exceptions relevant to your healthcare services.
During the public health emergency (PHE) over the last two years, there have been a lot of regulatory exceptions. These exceptions made regulatory compliance easier, allowing providers to skip some signatures, meet virtually, have less supervision, and more. The dates during which these exceptions applied are also important, so we recommend creating a folder for all the COVID exceptions that apply to your facility.
It is important to remember that any medical provider who submits claims to a government program may be subject to a Medicare or Medicaid audit. Just because you have been audited in the past, it doesn't change the fact that you may be audited again in the future. RAC audits are not one-time or intermittent reviews and can be triggered by anything from an innocent documentation error to outright fraud.
Timeliness is crucial when it comes to Centers for Medicare & Medicaid Services (CMS) audit responses, even when your team is bogged down by reduced staff, high patient loads, or other challenges. It is important to discuss with your contractor any COVID-19-related hardships you are experiencing that could affect audit response timeliness.
There are a few key things your practice can do to better prepare for a RAC Audit. Ensure that the auditor has the appropriate contact information for requesting audit-related documentation, and provide your internal audit review teams with proper access to data and software tools. It is a good idea to review and document any changes to your audit review team processes and to meet with your teams to ensure they fully understand the processes and are poised to respond within the required timeframes.
Never forget that the WCH team can assist you in preparing for audits by guiding regulatory compliance and ensuring that your practice is up-to-date with the latest rules and exceptions. Let us check your charts before the insurance will!
Source: https://medlearn.com/
