There are three types of RAC audits: automated, semi-automated, and complex. An automated audit does not involve review of the provider's medical records. However, a semi-automated review may involve manual review of records by RAC personnel, and a complex review can entail a comprehensive and invasive in-person review that can significantly disrupt your company's day-to-day operations.
Auditors may request to speak with billing personnel and other key employees as well; and, while providers are entitled to information about their audits, the process is often not as transparent as most providers would expect. These are among the numerous reasons why intervention and legal representation are critical, and why all providers need to be prepared to take proactive measures to protect themselves during the audit process.
Once the auditors have completed their review and the required discussion period has passed, the RAC will issue a determination of liability. If the RAC determines that that actions are needed and recoupments are owed, the provider must pay quickly (or quickly file an appeal) in order to avoid interest and other penalties.