RAC audits are becoming more common as auditors expand their reviews into additional states and specialties. Many of the audits to date have been focused on hospitals and surgical practices due to the high revenues associated with these providers. As the audits expand there are several things providers need to be aware of. One of the CPT billing codes with the highest hit rate in a RAC audit is the use of the New Patient billing codes.
One of the most commonly used is CPT code 99203. To use the New Patient billing codes the patient has to be new to the practice or can be an existing practice patient who has not been seen in the last three years. Some providers are not aware of these rules or use a new patient consult on an existing patient that presents with a new diagnosis. I have also seen a practice with multiple providers use the New Patient visit code for a patient who is established with the practice and regularly sees Dr. A and then due to scheduling reasons sees another physician with in the group and that physician seeing the patient for the first time charges a New Patient visit. Although the patient is new to that provider the group shares a common web based EMR for that patient and they are considered an established patient. During a RAC audit these patients will be flagged. Bottom line is to make sure providers are keeping current on coding rules or have certified coders involved in the coding process. Compliance with CMS coding guidelines and good documentation will greatly reduce a provider’s exposure in the event of a RAC audit.
To learn more watch MTBC’s RAC audit webinar video.