How payers identify claims that were improperly submitted for payment.
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Get it written →This chapter discusses how payers identify claims that were improperly submitted for payment. The Recovery Audit Program was implemented by CMS to identify and correct improper payments. Locate the most recent Medicare FFS RAC Report to Congress and associated appendices file located at https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Recovery-Audit-Program/Resources.
a. Why are facilities and providers unable to prevent the improper claims that the RACs have identified in their reviews?
b. What can providers and facilities learn from this report?
c. What key points can be identified and then implemented at the coder, physician, and clinician level to improve reporting processes?
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