Our legal battle continues

AHA News

Last week, the Centers for Medicare & Medicaid Services (CMS) issued two sets of regulations aimed at correcting its position on rebilling claims denied by Medicare contractors, including recovery audit contractors (RAC). The agency's interim ruling was a victory for hospitals. But its proposed long-term solution is not.

The interim rule took effect March 13, the date it was issued. It directs Medicare's administrative lawjudges to allow hospitals to claim Part B inpatient costs in cases where the patients received care in an inpatient setting.

The interim rule replaced a policy that required hospitals to return payment for the services they provided if they billed Medicare for Part A hospitalization services, rather than for Part B physician care.

But CMS designed the rule to be only a temporary solution. The agency also published a notice of proposed rulemaking for a longterm fix that would only allow hospitals to rebill CMS within the narrow time frame of one year from when patient services were provided. Since RACs typically review claims that are more than a year old, the practical effect would be that hospitals again would not receive fair reimbursement for the care they provide Medicare patients.

That is why the AHA is not backing down from our lawsuit against a rebilling policy that we believe violates Medicare and other laws and harms hospitals and patients. Under this policy, RACs have denied claims totaling hundreds of millions of dollars. And while hospitals prevail at least 72% of the time when they appeal these denials - andthousands of Medicare bills arepending on appeal over this issue - each appeal costs more time andmoney that could go to patient care.

We will continue to urge the agency to reimburse hospitals for claims they previously denied. Hospitals should be fully reimbursed for the care they provide to our nation's elderly citizens.

Our fight for full and fair reimbursement is championed on Capitol Hill by Reps. Sam Graves, R-MO, and Adam Schiff, D-CA, who this week introduced AHA-supported legislation that would make much-needed improvements to the RAC program and other Medicare audit programs (see story on page 3).

Please urge your representatives to co-sponsor the 'Medicare Audit Improvement Act,' H.R. 1250. It is critical to show strong congressional support for this important legislation that lays a foundation for making common-sense reforms to the audit system.

Topic: Advocacy and Public Policy

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