Healthicity Blog

The RAC program has been controversial ever since its inception when the Centers for Medicare and Medicaid Services (CMS) instituted the program to identify and correct Medicare improper payments through the detection of overpayments and underpayments made on healthcare claims.

As with most professions, medical coding takes a special kind of someone. Ideally a someone who is fun on the inside but sticks to the rules when it comes to their 9-5. A great coder must be educated in the field, dedicated, and someone who loves to learn.

Getting the most out of an E/M audit can be as simple as paying extra attention to common coding and documentation errors, common exam mistakes, and Medical Decision Making (MDM) mistakes.

"A Code of Conduct is fundamental to a successful compliance program because it articulates the organization’s commitment to ethical behavior.”

Organizations that fail to report overpayments within 60 days can be liable under the False Claims Act and may be subject to civil/criminal liabilities.

Healthcare fraud and abuse has the Department of Health & Human Services on the offense, poised and ready to strike. They’ve put measures in place to boost quality of care while reducing the government’s spending.

Compliance can be complicated: Keeping up with regulations, protecting your organization from loss of profit or even legal actions.

The OIG’s annual Work Plan is an important asset for optimizing your organization’s compliance and auditing efforts because it allows you to identify possible compliance risks.