All orthopedic physicians will be targeted for RAC audits.  As high-revenue, hi-volume producers, you will be targeted.

The unfortunate fact is that many of you may have already responded to the threat of an audit  by reducing fees, thereby self-imposing penalties. The thought being, that you are somehow less exposed for audit. Unfortunately that won’t work with RAC audits; as orthopedic physicians, you are already targeted.

Some consultants recommend benchmarking your practice and your E & M codes against national and state norms, but this is another approach that may self impose penalties.  The bottom line is you must code correctly, certainly not by under coding and self penalizing. Your practice could be a legitimate outlier.

The only fiscally reasonable response is to code correctly. Now that’s easy to suggest. So how do you do that? Well you could post a grid on the wall and measure every encounter against the 1997 AAOS Single organ system guidelines or you could use the 1995 guidelines and pretend you are primary care, get your stethoscope and go to work against those guidelines.

The best thing to do however, is to get an electronic medical record that understands your orthopedic workflow, that won’t slow you down and dynamically tells you where you are in regard to the 1997 AAOS guidelines at every point throughout the course of the physician/patient encounter. Phoenix Ortho is just such an EMR.

Click here to read an article by Patrick M. Palmer, MD, American Academy of Orthopaedic Surgeons, Board of Councilors.