Physicians, Be Wary of Medicare's RAC Audits

If you are audited, consider doing a case summary of the clinical presentations and the code choices. Write up a narrative of what the patient presented with, how the coder viewed the case, and the medical decision making involved. Also, linking the reason for admission and the emergency physician's work-up is important, Mr. Gaines said.

Emergency medicine groups also should be aware of the standard Medicare appeals process.

Although the standard appeals process applies to the RACs, the timelines for stopping recoupment of an improper payment are shorter than some of the standard appeals deadlines.