Core Competencies

Recovery Audit Solutions, Inc. (RASI) provides a broad range of payment integrity, data analytics, auditing, and compliance services for our clients. RASI’s experienced staff has the technical knowledge and skillset to perform audit reviews on all services and claim types.

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Acute Inpatient Hospitals

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Ancillary Services

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Billed Charge Audits

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Dental Services

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Durable Medical Equipment

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End-Stage Renal Disease (ESRD)

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High Cost Drugs

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Itemized Bill Audits

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Inpatient/Outpatient Psych

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Inpatient/Outpatient Rehab

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Home Healthcare

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Hospice Services

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Long Term Acute Care (LTAC)

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Nursing Home Facilities

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Outliers (extended inpatient stays)

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Outpatient Services

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Physician Services

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Pharmacy

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Skilled Nursing Facilities

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Vision Services

 Case Study

Outlier (Extended Inpatient Stay)

– Case Description

A patient admitted to a hospital is assigned a DRG that is tied to an average length of stay (ALOS). When the inpatient stay exceeds the ALOS the claim is vulnerable to a possible overpayment. RASI’s proprietary algorithms identify outlier claims resulting in a high error rate.

Summary

Patient was admitted to the hospital and during their stay, a procedure was performed. The procedure was delayed which caused additional charges for the delayed days. RASI’S proprietary algorithms and audit expertise resulted in a substantial reduction of the original payment for our client and the patient.

Benefit

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$33,716.95 dollars recovered in 30 days

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Improved internal processes

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Increased future savings

Final Result

Original Payment Amount: $77,523.17
New Payment Amount: $43,806.22
Savings: $33,716.95