The Centers for Medicare & Medicaid Services recently added a new form of recovery audit to their arsenal – semi-automated reviews.
Becker's Hospital Review explains that semi-automated reviews are a combination of automated reviews – those in which a hospital has made an obvious claim error – and complex reviews, which look into whether or not an error has occurred. Semi-automated reviews involve claims that are "more suspect" than those investigated with complex reviews, but not as obvious as the ones dealt with via the automatic method.
"Identified claims only contain possible errors – rather than assumed errors, as in a standard automated review," Kimberly Hoy, director of Medicare and compliance at HCPro, told HealthLeaders Media.
Semi-automated reviews are best suited to several areas of healthcare, such as claims for medically unlikely events. Becker's offers the example of a post-operative wound infection being drained more than three times in one day.
Scot McLeod, vice president at software solutions company Compliance 360, told the news source that automation can reduce hospitals' revenue losses and allow staff to spend less time on audits and more time caring for patients. Additionally, automated systems offer useful features such as due date reminders.
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