New RAC audits could prove burdensome to hospitals

Recovery audit contractors have implemented a new method for identifying provider overpayments--one that will require more legwork by hospitals to rebut, reports AIS Health Services.

The new method, called a semi-automated review, is similar to the automated reviews RACs currently use. However, they share a specific feature with a complex review, in that hospitals will have to submit medical records in order to support and verify their claims. RACs currently are limited to performing only 500 complex reviews per hospital every 45 days because it is considered an undue burden on hospitals to respond to more such reviews in a specific time period. However, there is no limit to semi-automated reviews.

"My concern is volume and my fear is they won't have a cap," said Heidi Shirk, RAC program coordinator for Penn State Milton Hershey Medical Center. "I hope CMS keeps in mind that there is no cap on automated reviews. They should take into consideration how many medical records they are asking for so they don't put a huge burden on facilities.

However, others believe the semi-automated reviews will provide more clarity to hospitals in dealing with RACs.

To learn more:
- read the AIS Health Services story (free reg. required)

Suggested Articles

Healthcare’s RCM processes are in dire need of a 21st-century update that delivers greater automation and real-time transparency.

Amazon's PillPack and Surescripts, owned by CVS Health and Express Scripts, are in a dispute over access to patient medication history data.

Presidential candidate Kamala Harris wants to get rid of the tax break drug companies get for direct-to-consumer advertising.