Peregrine RAC Audit Readiness Assessment™

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ASSESSMENT

SECTION 1

Documentation Excellence

Objective:Evaluate whether documentation consistently supports coding accuracy and medical necessity.

1. Provider documentation consistently supports the medical necessity of services billed.*

Always

Usually

Sometimes

Rarely

Never

Not Sure

2. Clinical documentation clearly supports the selected E/M level.*

Always

Usually

Sometimes

Rarely

Never

Not Sure

3. Procedure notes are complete, signed, and finalized promptly.*

Always

Usually

Sometimes

Rarely

Never

Not Sure

4. Documentation templates are reviewed periodically to align with current CMS guidance.*

Always

Usually

Sometimes

Rarely

Never

Not Sure

5. Documentation deficiencies identified during internal reviews are communicated back to providers.*

Always

Usually

Sometimes

Rarely

Never

Not Sure

SECTION 2

Coding Accuracy

Objective:Assess coding quality and billing accuracy.

1. Internal coding audits are performed regularly.*

Always

Usually

Sometimes

Rarely

Never

Not Sure

2. Coding updates are communicated to providers and billing staff.*

Always

Usually

Sometimes

Rarely

Never

Not Sure

3. Modifier usage is periodically reviewed.*

Always

Usually

Sometimes

Rarely

Never

Not Sure

4. High-risk CPT® and HCPCS codes receive additional oversight.*

Always

Usually

Sometimes

Rarely

Never

Not Sure

5. Billing edits, rejections, and coding trends are analyzed regularly.*

Always

Usually

Sometimes

Rarely

Never

Not Sure

SECTION 3

Revenue Cycle Monitoring

Objective:Evaluate how effectively the practice monitors revenue cycle performance.

1. Medicare denial trends are reviewed routinely.*

Always

Usually

Sometimes

Rarely

Never

Not Sure

2. Billing outliers and unusual utilization patterns are investigated.*

Always

Usually

Sometimes

Rarely

Never

Not Sure

3. Revenue cycle KPIs are reviewed by leadership on a regular basis.*

Always

Usually

Sometimes

Rarely

Never

Not Sure

4. High-dollar Medicare claims receive additional quality review.*

Always

Usually

Sometimes

Rarely

Never

Not Sure

5. Corrected claims are analyzed to identify recurring issues.*

Always

Usually

Sometimes

Rarely

Never

Not Sure

SECTION 4

Compliance Program

Objective:Measure the maturity of the practice's compliance program.

1. The practice maintains a written compliance program.*

Always

Usually

Sometimes

Rarely

Never

Not Sure

2. Providers receive ongoing documentation and coding education.*

Always

Usually

Sometimes

Rarely

Never

Not Sure

3. Internal audit findings result in documented corrective actions.*

Always

Usually

Sometimes

Rarely

Never

Not Sure

4. Compliance policies are reviewed and updated annually.*

Always

Usually

Sometimes

Rarely

Never

Not Sure

5. Compliance concerns are documented, investigated, and resolved.*

Always

Usually

Sometimes

Rarely

Never

Not Sure

SECTION 5

Audit Response Readiness

Objective:Determine how prepared the practice is to respond to a RAC audit.

1. The practice has a documented process for responding to an Additional Documentation Request (ADR).*

Always

Usually

Sometimes

Rarely

Never

Not Sure

2. Audit responsibilities are clearly assigned before an audit occurs.*

Always

Usually

Sometimes

Rarely

Never

Not Sure

3. Medical records can typically be retrieved within 48 hours.*

Always

Usually

Sometimes

Rarely

Never

Not Sure

4. Documentation is reviewed before submission to auditors.*

Always

Usually

Sometimes

Rarely

Never

Not Sure

5. Leadership understands the Medicare appeals process.*

Always

Usually

Sometimes

Rarely

Never

Not Sure

SECTION 6

Data Analytics & Risk Detection

Objective:Evaluate proactive monitoring of billing and compliance trends.

1. Billing data is reviewed regularly for unusual trends or outliers.*

Always

Usually

Sometimes

Rarely

Never

Not Sure

2. Revenue cycle reports are used to identify potential audit risks.*

Always

Usually

Sometimes

Rarely

Never

Not Sure

3. Coding, documentation, denial, and billing data are analyzed together.*

Always

Usually

Sometimes

Rarely

Never

Not Sure

4. Providers receive regular feedback regarding documentation or coding trends.*

Always

Usually

Sometimes

Rarely

Never

Not Sure

5. Reporting and analytics are used to proactively improve compliance.*

Always

Usually

Sometimes

Rarely

Never

Not Sure

Documentation Excellence Score

Coding Accuracy Score

Revenue Cycle Monitoring Score

Compliance Program Score

Audit Response Readiness Score

Data Analytics & Risk Detection Score

Overall Readiness Score

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