Pediatric Coding Alert

Fortunately, recent delays give you more time to plan for these audits.Because pediatric practices don't typically treat Medicare patients, you have probably been blissfully unaware of "recovery audit contractors" (RACs), which the federal government has hired to audit physician claims. But thanks to last year's Patient Protection and Affordable Care Act, it looks like RAC auditors will soon be reviewing Medicaid claims as well.In place for Medicare contractors since 2005, RACs are often referred to as medical "bounty hunters" because they only make money if they collect overpayments from you. Their income is specifically tied to the amount they recover, and is based on a percentage of the overpayments they identify."Medicaid RACs are tasked with identifying and recovering Medicaid overpayments and identifying underpayments," the CMS Web site notes. The agency sent a letter to each state's Medicaid director informing them of the RAC audit specifications (www.cms.gov/smdl/downloads/SMD10021.pdf). Initially, RACs were supposed [...]