What is automated review in this context?

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Multiple Choice

What is automated review in this context?

Explanation:
Automated review relies on data analytics to identify potentially improper payments across large sets of claims without first having a person read every medical record. In this RAC context, analytics, rules, and pattern recognition flag payments that look suspicious, and those flagged claims are then candidates for further investigation. The initial step is data-driven screening, not manual chart-by-chart review, which is what makes it different from a purely human process. This approach is not a random quarterly audit and is not limited to hospital claims, and it’s not simply a manual chart review.

Automated review relies on data analytics to identify potentially improper payments across large sets of claims without first having a person read every medical record. In this RAC context, analytics, rules, and pattern recognition flag payments that look suspicious, and those flagged claims are then candidates for further investigation. The initial step is data-driven screening, not manual chart-by-chart review, which is what makes it different from a purely human process. This approach is not a random quarterly audit and is not limited to hospital claims, and it’s not simply a manual chart review.

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