Recovery audit contractors (RACs) are professionals who work at the state level to identify payments that do not comply with Medicare and Medicaid regulations. Improper payments pose a risk to providers, so the goal of RACs is to track and correct them (Harrington, 2019b). Currently, rules are in place regarding the behavior of RACs, and providers can contact RACs coordinators for misconduct (Recovery Auditors / RACs, n.d.). Harrington notes that RACs allow for standardized payment processes because they operate according to clinical standards and Medicare coding and billing rules (Harrington, 2019b). It allows RACs to act as examiners for payment verification, maintaining financial stability within the organization. Consequently, RACs are tools for additional control of insurance program payments and regulation of improper payments.
Electronic health records (EHR) is a system that allows online tracking and collection of patient data. EHRs are IT products that simplify the processes of handling confidential information within an organization. EHRs provide quick access to information, access information remotely, and improve the accuracy of information (Harrington, 2019a). In addition, EHRs improve the quality of information and make care safer. The effectiveness of EHRs is determined by the ability to structure data (Blumenthal & Tavenner, 2010) and visualize data (Harrington, 2019a). EHRs provide systems for transferring information between employees to clarify diagnoses (for example, after laboratory tests) and up to the patient. Existing systems for patient access to information make it easier to provide a diagnosis and to convince treatment or hospitalization (Blumenthal & Tavenner, 2010). EHRs simplify motivational channels for staff: treatment data becomes visible, and staff can evaluate outcomes. EHRs are needed to visualize information and improve provider performance characteristics.
References
Blumenthal, D., & Tavenner, M. (2010). The “meaningful use” regulations for electronic health records. The New England Journal of Medicine, 363(6), 501-504.
Harrington, M. K. (2019a). Electronic health records and meaningful use. In Health Care Finance and the Mechanics of Insurance and Reimbursement (2nd ed.) (pp. 205-220). Jones & Bartlett Learning.
Harrington, M. K. (2019b). Recovery audit contractors. In Health Care Finance and the Mechanics of Insurance and Reimbursement (2nd ed.) (pp. 241-251). Jones & Bartlett Learning.
Recovery Auditors / RACs. (n.d.). AMA.