Over-reach of RACs highlighted at AHA briefing

AHA News Now

Leaders from four hospitals and health systems briefed congressional staff Friday on the problems they face due to inappropriate payment denials by Medicare recovery audit contractors. For example, Steven Hanks, M.D., executive vice president and chief medical officer at The Hospital of Central Connecticut, described the types of inpatient hospital services being denied by RACs – and the patients who need the services. He noted that despite medical need, RACs are denying payment for these services on the grounds that the care should have been provided in the outpatient setting. However, he said the hospital has appealed 96% of the denials and 94% were successfully overturned. “We want bills to go out correctly the first time and we agree that any payer should be assured accuracy,” Hanks said. “We also agree that fraudulent and abusive practices should be rooted out and vigorously prosecuted. RACs have nothing to do with fraud and abuse. It’s not a level playing field when RACs are paid on commission to indiscriminately deny claims.”

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