Discussion Reply- Response 1-2 paragraphs with 1-2 references

Andria Byrd

To prepare for the recovery audit, I would first visit the CMS website to review updates and understand what the audit will consist of and what the organization should prepare for and expect. CMS (2020) states that the audit's mission is to identify and correct Medicare improper payments through the efficient detection and collection of overpayments made on claims of health care services provided to Medicare beneficiaries. The website also covers what topics could be reviewed and contact information for region-specific Recovery Audit Contractors (RACs).

With this information, I would then prepare to collaborate with internal departments, medical records, claims & coding to begin addressing topics before the audit. The website provided a list of approved RAC topics and proposed RAC Topics, so I would be sure to review each list to obtain each topic applicable to the organization (CMS,2020). I would then determine the type of review taking place for each topic. There are three types of reviews, automated (no medical record needed), Semi-Automated (claims review using data and potential human review of a medical record or other documentation, and complex (medical record required). With this information, I would conduct an internal assessment to make sure the organization is compliant with Medicare rules.

Collaboration between medical records, coding, and claims departments would need to take place. The best practice would be to prepare to provide all information requested in the audit letter (Alder, 2017). This includes medical records, invoices for drugs and suppliers, and other materials (Alders, 2017). With collaboration between these internal departments, the organization will successfully complete the audit since the medical records department is responsible for maintaining records and the coding & claims departments are responsible for billing and submitting claims to CMS.

The Coding and Claims Department is responsible for:

· Properly coding services, procedures, diagnoses, and treatments

· Preparing and sending invoices or claims for payment

· Correcting rejected claims

· Tracking payments

· Following up with patients and insurance companies about outstanding bills

(Ultimatemedical.edu, 2021)

The Medical Records Department is responsible for:

· Gather patient demographic and personal information.

· Issue medical files to persons and agencies according to laws and regulations.

· Help with departmental audits and investigations.

· Distribute medical charts to the appropriate departments of the hospital.

· Maintain quality and accurate records by following hospital procedures.

· Ensure patient charts, paperwork, and reports are completed in an accurate and timely manner.

· Make sure all medical records are protected and kept confidential.

· File all patients' medical records and information.

· Supply the nursing department with the appropriate documents and forms.

· Completes clerical duties, including answering phones, responding to emails, and processing patient admission and discharge records.

(Betterteam.com, 2020)

Reviewing each department's responsibilities demonstrates why each department's role is vital to the auditing process for ensuring compliance.

Resources:

CMS.gov (2020). Medicare Fee for Service Recovery Audit Program. Retrieved from https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Recovery-Audit-Program

Alder, E. (2017). How to Handle and Audit from Medicare or Other Payers. Retrieved from https://www.physicianpractice.com/view/how-handle-audit-medicare-or-other-payers

Betterteam.com. (2020). Medicare Records Clerk Job Description. Retrieved from https://www.betterteam.com/medical-records-clerk-job-description#:~:text=A%20Medical%20Records%20Clerk%20is,diploma%20and%20proven%20work%20experience .

Ultimatemedical.edu. (2021). What Is a Medical Coding and Billing Specialist? Retrieved from https://www.ultimatemedical.edu/blog/what-is-a-medical-coding-and-billing-specialist/