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- Services
Medical Billing and Practice Management
Creative Collection Solution
MD Audit Shield – RAC
Physician Credentialing
EMR/EHR Software
Electronic Fund Transfer (EFT)
CodeMAXX Services
Hippa
Defend Your Practice Against RAC Audits Before They Strike
Recovery Audit Contractor (RAC), MAC, ZPIC & OIG audits cost healthcare practices millions in overpayment demands and penalties. MD Audit Shield builds your defense — before the audit letter arrives.
What Is a RAC Audit — and Why Your Practice Is at Risk
A Recovery Audit Contractor (RAC) is a CMS-authorized program that reviews paid Medicare and Medicaid claims for billing errors, coding inaccuracies, and overpayments — then demands repayment with penalties.
RAC auditors work on contingency — they earn a percentage of every dollar they recover. That creates aggressive, targeted audits even when your practice did nothing intentionally wrong. Incorrect ICD-10 coding, missing medical necessity documentation, and prior authorization gaps are the most common triggers in 2025.
Every Federal Audit Type — One Unified Defense Program
From routine Medicare claim reviews to OIG fraud investigations, MD Audit Shield covers every audit type that can impact your practice's revenue and reputation.
| Audit Type | Full Name | Primary Focus | Typical Timeline | Risk Level |
|---|---|---|---|---|
| RAC | Recovery Audit Contractor | Overpayments & underpayments in Medicare claims | 120–180 days | Critical |
| MAC | Medicare Administrative Contractor | Medical necessity, documentation, billing accuracy | 30–90 days | High |
| ZPIC / UPIC | Zone Program Integrity Contractor | Fraud, waste & abuse investigations | 90–365 days | Critical |
| OIG | Office of Inspector General | Compliance, exclusions, corporate integrity | 6–24 months | Critical |
| CERT | Comprehensive Error Rate Testing | Random sample review of claim accuracy | 60–120 days | Moderate |
| Pre-Pay | Pre-Payment Review | Documentation review before reimbursement releases | Ongoing | High |
| SMRC | Supplemental Medical Review Contractor | Targeted review of high-volume billing codes | 30–60 days | High |
Complete RAC Audit Defense & Medicare Compliance Services
Every tool your practice needs to prevent audits, survive them, and recover overpayment demands — backed by AAPC-certified coders and healthcare compliance specialists.
RAC Audit Defense & Medicare Appeals
Full-service RAC audit response — from initial overpayment demand letter through all five levels of the Medicare appeals process, with complete documentation packages at each stage.
- RAC demand letter analysis & response
- Medical record compilation & review
- Redetermination & reconsideration filing
- ALJ hearing preparation & representation
- Overpayment recoupment suspension requests
Medicare Compliance Audit
Proactive internal compliance review that mirrors what CMS auditors examine — identifying ICD-10 coding errors, documentation gaps, and medical necessity issues before they trigger external scrutiny.
- ICD-10 & CPT coding accuracy review
- Medical necessity documentation check
- HCPCS Level II coding validation
- Compliance risk scoring by service line
Medical Record Documentation Review
AAPC-certified coders review your medical records for documentation completeness — ensuring every claim is fully supported and audit-ready before payers examine it.
- Pre-submission record completeness check
- E/M level documentation validation
- Physician note & order review
- HIPAA-compliant record handling
Overpayment Appeal & AR Recovery
When CMS or a contractor demands repayment, our accounts receivable specialists fight back — handling overpayment appeals and protecting your revenue from automatic deduction.
- Overpayment demand dispute management
- Recoupment suspension requests
- Extended repayment plan negotiation
- AR recovery & collections tracking
HIPAA-Compliant Audit Workflow
Every document, communication, and record submission in the MD Audit Shield process runs through AES-256 encrypted, HIPAA-compliant workflows with full Business Associate Agreement coverage.
- AES-256 encrypted data handling
- BAA execution with every client
- No Surprises Act alignment
- Secure medical record transmission
Physician Credentialing & Payer Enrollment
Expired or missing credentialing is a top RAC audit trigger. Our team keeps CAQH profiles current, payer enrollments active, and re-credentialing on schedule across all specialties.
- CAQH profile setup & maintenance
- Payer enrollment applications
- Re-credentialing & renewal management
- Credentialing gap audit & remediation
MD Audit Shield: Our 5-Step Defense Process
From your first free audit risk assessment through ongoing compliance monitoring — a clear, proven process that protects your revenue cycle from day one.
Specialty-Specific RAC Audit Defense Across 30+ Healthcare Specialties
Different specialties face different audit triggers. Our coders and compliance specialists understand the ICD-10, CPT, and medical necessity rules specific to your field.
Mental Health & Behavioral Health
Session-based CPT codes (90837, 90834) and modifier requirements are among the most-audited codes by RAC contractors. We specialize in behavioral health documentation standards and medical necessity criteria.
Cardiology & High-Complexity Specialties
High-dollar procedures and complex E/M coding in cardiology, oncology, and surgical specialties attract disproportionate RAC scrutiny. We know every documentation requirement for complex cases.
Home Health & DME Providers
Home health certifications, HCPCS Level II medical necessity, and durable medical equipment documentation are high-frequency RAC targets. Our compliance reviews keep your records airtight.
Why Healthcare Practices Choose MD Audit Shield
Ready to Protect Your Practice Revenue from RAC Audits?
Most practices don't know their audit exposure until a demand letter arrives. Our free assessment identifies your top ICD-10 coding vulnerabilities, documentation gaps, and Medicare overpayment risk — so you can act before auditors do.
- ✓ 98.5% clean claim rate with AAPC-certified medical billing
- ✓ RAC, MAC, ZPIC & OIG audit defense — all federal audit types covered
- ✓ ICD-10 and CPT coding specialists for 30+ medical specialties
- ✓ HIPAA-compliant workflows — AES-256 encrypted data handling
- ✓ No long-term contract required to get started
Get Your Free RAC Audit Assessment Today
No commitment required · HIPAA Compliant · Nationwide
Our RAC audit defense and Medicare compliance services are exclusively available to US-based healthcare providers. Start your free audit risk assessment and find out if your practice has documentation gaps or coding vulnerabilities before federal auditors do.
Get a Free Audit Assessment →RAC Audit Defense — Related Articles
Stay ahead of Medicare audit trends with expert guidance from the Pro Health Care Advisors compliance team.
Top 10 RAC Audit Triggers in 2025 — and How to Avoid Them
CMS has expanded the approved RAC audit topic list significantly. Learn which billing codes and documentation gaps are drawing the most federal scrutiny this year.
Get Free Assessment →ICD-10 Coding Errors That Trigger Medicare Audits — A Provider's Guide
Incorrect ICD-10 coding is the number one cause of RAC audit selection. This guide covers the most common coding mistakes across 10 specialties and how AAPC-certified review prevents them.
Read Article →The 5 Levels of Medicare Appeals — What Happens After a RAC Demand Letter
Receiving a RAC overpayment demand is not the end — it's the start of a formal appeals process. Here's exactly how each of the five Medicare appeal levels works.
Talk to a Specialist →Recovering Denied Medicare Claims: A Practice Manager's AR Recovery Guide
Denied and underpaid Medicare claims represent significant lost revenue. Learn how proactive AR recovery and overpayment appeal strategies recapture revenue most providers assume is gone.
Read Article →