Why are facilities and providers unable to prevent the improper claims that the RACs have identified in their reviews?

Facilities and providers often struggle to prevent improper claims identified by Recovery Audit Contractors (RACs) due to a combination of complex billing regulations, inadequate training on coding practices, and the high volume of claims processed. Additionally, healthcare providers may lack the resources or systems needed to ensure compliance with ever-changing guidelines, leading to oversight. Furthermore, the pressure to maximize reimbursement can sometimes result in unintentional errors in claim submissions.