Revenue Cycle

RACs using 'semi-automated' claims review

Recovery Auditor Report, April 7, 2011

Providers familiar with automated claims reviews and complex claims reviews by the recovery audit contractors (RAC) now face another method of overpayment identification: “Semi-automated” claims review.

Semi-automated review strays a bit from the automated and complex methods of overpayment identification recognized in the RAC statement of work, but is essentially a hybrid of the two primary techniques.

So with this new method, what exactly changes?

Not much, really. CMS breaks this new review process into two parts. The first piece of the two-part review process involves automated review of claims data to identify billing aberrancies with a high index of suspicion of improper payment.

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