Revenue Cycle

Q&A: Academic medical center RAC vulnerabilities

Recovery Auditor Report, September 16, 2010

Question:Are academic programs that practice more evidence-based medicine at a lower risk of audit versus community-based hospitals? Is there a difference because the hospital is in an academic setting?

Answer: (Via Michael Taylor, MD, vice president of clinical operations at Executive Health Resources in Newton Square, PA)

From my experience, unfortunately university and academic centers are not protected and one reason to keep in mind is that these are big targets. Universities are performing some of the highest-dollar, cutting edge procedures; and clearly at some of these facilities they’re performing the highest-dollar procedures with a relatively shorter stay than their peers. It stands to reason, and we’ve seen in many cases that universities and academic centers — with a slightly different patient mix — may show up differently on statistical analysis. When those centers are providing care that differs from their peers, they can be targeted for audit.

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