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RACFacts: How do RACs review claims?

How do RACs review claims?

Have you ever wondered how Recovery Auditors look at Medicare claims? How do they decide what issues to review, and who actually participates in the review process?

Recovery Auditors employ numerous staff from the medical field to assess claims – Medical Directors, Nurses, Coders and countless healthcare reimbursement experts. All three types of review outlined below are overseen by the auditor’s Medical Director.

Following is a diagram that walks through the process that takes place inside a Recovery Audit company. 

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Recovery Auditors have returned nearly $10 billion to the Medicare Trust Fund while reviewing no more than 2%of any provider’s claims.  

 

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