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Please write a 450 word reply discussion post to the following post. Must have two peer reviewed sources AND one biblical integration. Instructions of original post are here:
Explain the history and purpose of the Recovery Audit Contractor (RAC) demonstration project, as well as the process of the RAC as it pertains to its impact on healthcare organizations.
Post you will reply to is here:
According to Harrington, a Recovery Audit Contractor is defined by the Centers for Medicare and Medicaid Services as the role that detects and corrects improper Medicare payments (2021). Recovery audit contractors can audit healthcare payments after funds and claims have been dispersed. RAC’s work to avoid the negative impacts to the financial health of he healthcare organization ( Harrington, 2021).
History
The Recovery Audit Contractor program was created under the Centers for Medicare and Medicaid Services ( CMS ) and is responsible for identifying and correcting improper Medicaid payments that were paid to health care providers under the fee – for- service ( FFS ) Medicare plans (ACC, 2023). Those payments could either be underpayments or over payments to patient accounts. This program derived from a demonstration program which used Recovery Auditors to go into various health care settings to look for over patient charts or records (ACC, 2023). While looking for underpayments and any overpayments auditors were also looking to aid in identifying future improper payments as well as lowering the overall error rate for processing a Medicare claim (Harrington, 2021).
The Recovery Audit Demonstration ran from 2005 to 2008 and was a part of section 306 of the Medicare Prescriiption Drug , Improvement , and Modernization Act of 2003 (Harrington, 2021). At the start of the program in 2005 , RAC performed the work of reviewing , auditing , and identifying improper Medicare over or under payments (Green, 2018 ). Examples of overpayments are claims submitted that do not meet Medicare’s National Correct Coding Initiative or medical necessity policies, documentation in the patient record that does not support the codes reported on the claim (Green, 2018). Healthcare providers subject to review include hospitals, physician practices, nursing homes, home health agencies, durable medical equipment suppliers, and any other supplier (Green, 2018). The national RAC program is an outgrowth of a successful demonstration program that used RACs to identify Medicare overpayments and underpayments to healthcare providers and suppliers (Green, 2018). The RAC program uses program integrity contractors (RAC auditors) who review billing trends and patterns across Medicare programs (Green 2018). The RAC auditors focus on facilities, organizations and individuals such as providers where billings for Medicare services are higher than the majority of providers and suppliers in the community (Green, 2018).
Process and Impact
The Recovery Audit Contractor uses the automated and the complex review processes to review Medicare claims (ACC, 2023). In the automated review process, once an improper payment is identified, the RAC contacts and notifies the healthcare provider of the improper payment that they have received and actions will be taken to collect that amount from the provider (ACC, 2023). If it is an underpayment that the provider received from CMS and then that amount will be paid to the proper provider (Harrington, 2021). In the complex review process, after an improper payment has been identified, the next step is for the RAC to request medical records for the patient that is in question (Harrington, 2021). These medical records will help identify where the error occurred for the payment process. The RAC will then find out if there was an overpayment or underpayment which is the most important part of this claim process. The impact of RAC on healthcare organizations is that, it helps the organization develop a good tracking system that will provide easy access to required data and also helps to identify improvement opportunities that are needed (Harrington, 2021). Whether those improvements need to come from the billing and coding department or from the actual provider information, change can come from the findings of the RAC for the betterment of the medical facility.
Biblical
The auditing of medical records for over payment or underpayment makes me think of if we have under paid during our lives to Christ. Romans 14:11-12 states “As I live, says the LORD, every knee shall bow to me, and every tongue shall confess to God, So then each of us shall give account of himself to God” (NKJV, 2022). I feel like we always underpay Christ. So if we were to do an audit on our lives can we see where we have bowed our knees and confessed who God is to us and be able to give an account to him?
References
ACC. (2023). American College of Cardiology. What are recovery audit contractors? Accessed May 7, 2023. https://www.acc.org/Tools-and-Practice-Support/Practice-Solutions/Medicare-Enrollment-and-Claims-Submission/Recovery-Audit-Contractors/What-are-RACsLinks to an external site.
Green, Michelle A. Understanding Health Insurance: a Guide to Billing and Reimbursement. Cengage Learning, 2018.
Harrington, M. K. (2016). Health care finance and the mechanics of insurance and reimbursement. Burlington, MA: Jones & Bartlett Learning.
NKJV. (2022). Romans 14:11-12. New King James Version. Bible. Accessed via YouVersion App.