The Recovery Audit Contractor program is an essential topic for workers of the medical sphere. Although it is often viewed liked excessive bureaucracy outlay and waste of money by physicians, it helps control the payment system of the US clinics. The program evolved from the initiatives of the Centers for Medicare and Medicaid Services to develop an assessment of the various medical sphere’ departments. Multiple evaluation systems were arranged; RAC was meant to examine and control the financial correctness of the hospitals (Harrington, 2019). Initially, the program was employed as a demonstration projects with the three years term. It should have detected the errors in individual bills of contractors and organizations’ financial apparatus. However, the program was effective, and its executives proposed valuable solutions to payment methods and errors reduction. As a result, the Medicate approved the program for permanent work (Harrington, 2019). Thus, a project aimed at temporal problem solving proved to be a helpful tool for enhancing the healthcare system.
The program’s design is relatively complex, which produced numerous issues in the payment regulations. Namely, the RAC staff was given a part of improper payments recognized by them; this factor has driven some workers to attempt to find the most costly errors (Zelman et al., 2020). However, the Medicare Audit Improvement Act corrected the issue by implementing fines for a selective approach for work. Nowadays, the payments for revision are chosen by the criteria of frequent mistakes in the area. Additionally, clinicians with proper medical education review the reports of RAC workers. It is especially important since various medical services are not coded for payments, as a result being billed inappropriately (Zelman et al., 2020). Moreover, unnecessary services could be revealed after analysis provided by RAC professionals (Harrington, 2019). Therefore, the program was improved thoroughly since its inception in the clinics of the US.
The algorithms used by RACs are derived from years of experience. The workers are not given the cases of improper payments; instead, they should define the areas where the errors occur the most frequently or any suspicious organizations (Harrington, 2019). After that, the RAC workers send warnings to the providers of medical services who have received an underpaid bill or excessive amount of money for their work. Virtually, the improper fees are overpaid bills collected by dishonest or inexperienced providers (Harrington, 2019). Furthermore, medical assistants furnish detailed reviews of the cases, estimating the necessity of various services. The coding system developed by Medicate is used by RAC as well since it is composed by professionals in medicine. The appeals made by RACs undergone several stages; during them, additional analysis of a request is done, and a possibility to argue with the payment decision is given to providers. Finally, if providers do not meet the demand and cannot substantiate their position, the RCAs can transfer the case to the judicial organizations (Harrington, 2019). In brief, the RCA performance aims to control the improper payments that present a specific thread for dishonest clinicians.
The RAC program had the purpose of changing the medical financial sphere, and it still performs appropriately for achieving this goal. The initiative makes the process of billing a transparent one so that customers and providers participate in honest and reliable contracts. Hence, the RAC has impacted the organizational structure of clinics’ monetary policies positively, making them safe and open to reimburse in the unfair billing cases.
References
Harrington, M. K. (2019). Health care finance and the mechanics of insurance and reimbursement (2nd ed.). Jones & Bartlett Learning.
Zelman, W. N., McCue, M. J., Glick, N. D., & Thomas, M. S. (2020). Financial management of health care organizations: An introduction to fundamental tools, concepts and applications (5th ed.). Jossey-Bass.