ICD10monitor March 6, 2024
Healthcare providers are starting to see the first claim audits based on analysis and determinations made by artificial intelligence (AI).
Although the technology is new, many of the issues remain the same. Especially when the companies that develop AI-based audit tools sell these tools and services to commercial insurance companies, AI-driven audits increasingly resemble audits of Medicare providers and suppliers performed by the Recovery Audit Contractors (RACs) or Unified Program Integrity Contractors (UPICs).
RACs and UPICs are Medicare contractors charged by the Centers for Medicare & Medicaid Services (CMS) to identify overpayments and underpayments made to providers and to facilitate return of overpayments to the Medicare Trust Fund. Primarily, RACs accomplish this by conducting audits and issuing repayment demands.
RACs...
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