RACs are Revenue Contract Auditors the government has deployed for the sole purpose of combating fraud and abuse. They are paid a direct percentage of any fraudulent or incorrect claim successfully fined. According to their respective agency, every medical office should be prepared to be audited at least once by October 1, 2014, otherwise known as the ICD-10 transition. thew following are a few procedures you should follow to help reduce your risk of committing medical billing fraud:

1. Be sure to charge the same amount for each procedure, regardless of what insurance the patient has.

2. Be sure you are charging your patients their co-payments. If you would like to waive their copay due to financial hardship, be sure the correct paperwork is completed.

3. Do not schedule unnecessary visits.

4. Do not accept kickbacks for referrals.

5. Have a compliance manual in place, and ensure your office staff is properly trained to utilize it.

At present, the law states that any person who commits any form of fraud will be fined or imprisoned for no less than 5 years, or both! You must pay attention to detail and be aware of what is going on in your office at all times. Even if the error is “your biller’s mistake”, guess who pays the price?You! These fines are not cheap…Typically they are equal to the amount of the claim, plus up to $250,000.00 for the felony. Definitely not pocket change!

By Candy Caverley: Founder, Signet Medical Training


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