A RAC or commercial payer requests records for selected physician-office claims under audit. What is the appropriate response approach?
Select an answer to reveal the explanation.
Short Explanation
When a RAC or payer knocks, send the whole authenticated story on time—not a half-note, not a scrubbed version. Completeness and deadlines matter more than creative editing.
Full Explanation
External audit responses require timely submission of complete, authenticated medical records that substantiate the services and diagnoses billed. When a RAC or commercial payer requests records for selected physician-office claims under audit, the appropriate response approach for a civic practice is to provide complete, authenticated records that support the billed services within the requested timeframe. Omitting relevant pages, sending unsigned drafts, or missing deadlines increases denial, overpayment, and broader compliance risk. Submitting only unsigned drafts to respond faster than the deadline fails authentication and completeness expectations and can worsen the audit outcome. Ignoring the request if the claims were paid more than 30 days ago fails because lookback periods and request obligations are not extinguished by a 30-day payment age. Providing incomplete charts that omit unfavorable pages fails as selective disclosure and intensifies regulatory exposure. Exam caveat: response timelines, preferred portals, and record-set expectations are payer-specific—calendar the due date immediately and follow the request letter’s instructions exactly. Operational check: log the request the day it arrives, assemble complete authenticated records through a controlled HIM process, validate signatures before upload, retain shipping/portal proof, and brief municipal compliance leadership before the deadline.