Pay-for-Performance and Recovery Audit Contractors: the whys and wherefores of these programs.
Pay-for-Performance programs reward physicians, hospitals, and other providers of healthcare when the services they provide reach predetermined quality and efficiency goals. On the other hand, the Recovery Audit Contractor program is a form of Pay-for-Performance through which private companies hired by the Centers for Medicare & Medicaid Services identify improper payments made on claims of healthcare services to Medicare beneficiaries. Pay-for-Performance programs and the Recovery Audit Contractor project are discussed in this article in an effort to provide a baseline of understanding about these programs to those working in peri-operative areas.
Catalano
Kathleen
K
Perot Systems' Clinical Solutions Center, 2300 W Plano Parkway, Plano, TX 75075, USA. Kathleen.catalano@ps.net
D000574:American Medical Association / Q000458:organization & administration; D014487:Centers for Medicare and Medicaid Services, U.S. / Q000458:organization & administration*; D003284:Contract Services / Q000458:organization & administration*; D006801:Humans; D007345:Insurance Claim Review / Q000458:organization & administration*; D054539:Medication Therapy Management / Q000458:organization & administration; D015969:National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division / Q000458:organization & administration; D012052:Reimbursement, Incentive / Q000458:organization & administration*; D014481:United States