Fritz Joseph V, Setlock Sandra, Grooms Daneen P
Dent Neurologic Institute (JVF, SS), Buffalo, NY; and Regulatory Affairs (DPG), American Academy of Neurology, Minneapolis, MN.
Neurol Clin Pract. 2013 Jun;3(3):224-232. doi: 10.1212/CPJ.0b013e318296f2ac.
Recovery Audit Contractors (RACs) are contracted by the federal government to review providers' medical billing. Experience has demonstrated substantial savings to the strapped Medicare fund, fueling increased scrutiny. RAC audits are constrained to published focus areas, and its targeted approach makes use of sophisticated analytics. Although some of the analyses used by the RACs may be proprietary, much of the auditing process is transparent, allowing providers to prepare their practices in advance of audits. This article reviews the current state of RAC auditing and offers strategies to minimize financial pain and leverage the process for competitive advantage.
医保回收审计承包商（RACs）受联邦政府委托，负责审查医疗服务提供商的医疗账单。经验表明，这为资金紧张的医疗保险基金节省了大量资金，从而加大了审查力度。RAC审计限于已公布的重点领域，其目标明确的方法采用了复杂的分析手段。虽然RACs使用的一些分析方法可能是专有的，但大部分审计过程是透明的，这使医疗服务提供商能够在审计前做好准备。本文回顾了RAC审计的现状，并提供了一些策略，以尽量减少财务损失，并利用这一过程获取竞争优势。
