Recovery audits show gaps between administrators and physicians

Recovery audit contractors who require proper documentation of all insurance claims made at hospitals can show the gaps that exist between hospital administrators and doctors, writes Leo Paul D'Orazio for RAC Monitor.

D'Orazio writes that the problems stem from an imbalanced incentive system. Since hospital claims are dependent on a physician's medical records and not cooperating with the recovery audit contractor, both parties have entirely different financial incentive systems to follow. As a result, D'Orazio states, hospitals need to find a way to make cooperation with RACs a profitable engagement.

"A hospital may want to organize an RAC committee that would be responsible for reviewing samples of data on claims, admissions, documentation and coding, in order to identify common errors. All findings should be shared [with necessary hospital officials]," D'Orazio writes.

The mandates of the new national healthcare system will demand that hospital officials and physicians improve their communication channels. All parties can take a big step toward compliance by properly engaging with recovery audit contractors.

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