The United States of America envisions the country providing affordable and quality health to Americans. There is a huge challenge to overcome fraud waste and abuse, medical errors and medical necessity determination. The problem of improper payments has to be dealt intelligently to avoid under and over coding.

Every common layman knows that only reforms can bring revolution in healthcare, president Obama has put emphasis on the reforms very much but only spending money on the name of reforms would not actually change the healthcare system it is about the "effectiveness of system" that will bring the change.

One of the core features of the Obama plan is the claim that every family will save about $2,500 per year. The plan accommodates a Health information technology investment aimed at tumbling unneeded expenses that result from preventable errors and infertile paper billing systems. It will also help preventing and organizing of unrelenting circumstances. The preparation is required to raise insurance industry competition and reduce underwriting costs and profits in order to reduce insurance overhead. The health insurance should be universal which will diminish spending on uncompensated care.

The government has come up with RAC (Recovery Audit Contractor) which has completed its demonstration and now the government is thinking on lines to go nationwide with RACs. Just because the amount is significant in term of recovery, RACs are satisfactory for CMS in reality the percentage of recovery is far lesser than the potential. This system requires utmost utilization of human resources whereas an intelligent Electronic health Record system would pin point the problem at first stage. It will reduce a lot of cost and the wastage of resources.

The strategy and Tactics both are off beam in RACs case. It is quite simple, despite going in to the root cause; all the effort is to eliminate the problems occurred due to that root cause. RAC primarily task is to recover the payments either under payments or overpayments, but why not address the main problematic area. The spotlight should be on the system that does not allow improper payments rather then after improper payments making efforts to recover them. Both strategy (which direction to go?) and Tactic (how to get there?) are erroneous.

With more than 15 years of experience and expertise, Manzoor Hasan MBA, MST, CPA, is CEO at e-Health Vision Inc. and a seasoned consultant in healthcare and other corporate entities. He has extensive expertise in medical management, physician recruitment and as a liaison in negotiations with hospitals, managed care organizations, group practices, HMOs and others.


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