| The United States of America envisions the | | | | spending on uncompensated care. |
| country providing affordable and quality health to | | | | The government has come up with RAC |
| Americans. There is a huge challenge to | | | | (Recovery Audit Contractor) which has completed |
| overcome fraud waste and abuse, medical errors | | | | its demonstration and now the government is |
| and medical necessity determination. The problem | | | | thinking on lines to go nationwide with RACs. Just |
| of improper payments has to be dealt intelligently | | | | because the amount is significant in term of |
| to avoid under and over coding. | | | | recovery, RACs are satisfactory for CMS in |
| Every common layman knows that only reforms | | | | reality the percentage of recovery is far lesser |
| can bring revolution in healthcare, president | | | | than the potential. This system requires utmost |
| Obama has put emphasis on the reforms very | | | | utilization of human resources whereas an |
| much but only spending money on the name of | | | | intelligent Electronic health Record system would |
| reforms would not actually change the healthcare | | | | pin point the problem at first stage. It will reduce |
| system it is about the "effectiveness of system" | | | | a lot of cost and the wastage of resources. |
| that will bring the change. | | | | The strategy and Tactics both are off beam in |
| One of the core features of the Obama plan is | | | | RACs case. It is quite simple, despite going in to |
| the claim that every family will save about $2,500 | | | | the root cause; all the effort is to eliminate the |
| per year. The plan accommodates a Health | | | | problems occurred due to that root cause. RAC |
| information technology investment aimed at | | | | primarily task is to recover the payments either |
| tumbling unneeded expenses that result from | | | | under payments or overpayments, but why not |
| preventable errors and infertile paper billing | | | | address the main problematic area. The spotlight |
| systems. It will also help preventing and organizing | | | | should be on the system that does not allow |
| of unrelenting circumstances. The preparation is | | | | improper payments rather then after improper |
| required to raise insurance industry competition | | | | payments making efforts to recover them. Both |
| and reduce underwriting costs and profits in order | | | | strategy (which direction to go?) and Tactic (how |
| to reduce insurance overhead. The health | | | | to get there?) are erroneous. |
| insurance should be universal which will diminish | | | | |