Tag: RAC Audits

Upcoding and Downcoding Errors

Avoiding Upcoding and Downcoding Errors in Modern Healthcare Organizations

In today’s healthcare environment, accuracy is more than a compliance requirement — it is the foundation of trust, financial stability, and quality patient care. Modern healthcare organizations operate in a complex ecosystem of regulations, payer policies, documentation standards, and technology platforms. Within this environment, medical coding plays a critical role in translating patient care into […]
Evolution of Recovery Audit Contractor (RAC) Audits: Challenges, Changes, and Current Landscape

Evolution of Recovery Audit Contractor (RAC) Audits: Challenges, Changes, and Current Landscape

The inception of Recovery Audit Contractor (RAC) audits dates back to 2005, reaching their zenith around 2010 before encountering a deceleration amidst the COVID-19 period. In 2006, Congress granted the Centers for Medicare & Medicaid Services (CMS) the authority to launch the Recovery Audit Contractor program across three initial states: New York, Florida, and California. […]