Semi-automated reviews may place strain on audited hospitals

Recovery audit contractors have recently implemented a new semi-automated review method for identifying provider overpayments and duplicate payments, according to Fierce Health Finance.

Despite similarities to the automated review process currently being used by RACs, hospitals will have to submit medical records to verify their claims – a step required by complex reviews. Because of the burden this places on hospitals, RACs are restricted to performing 500 complex reviews per hospital for every 45 days of an audit. However, an unlimited number of semi-automated reviews are allowed to be conducted.

"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, quoted by the news source. "They should take into consideration how many medical records they are asking for so they don't put a huge burden on facilities."

A recent report by the Centers for Medicare & Medicaid Services found that RACs recouped $237.8 million during a period of six months that ended in March, according to The Hill. 

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