Overzealous RACs

AHA News

Hospitals from across the country are raising their voices over the redundant government auditors, unmanageable medical record requests and inappropriate payment denials that are part and parcel of Medicare’s recovery audit contractor (RAC) program. Be assured that the AHA is advancing your concerns with RACs before the courts, Congress and the Centers for Medicare & Medicaid Services (CMS).

For example, we’ve recently criticized the limited scope of CMS’ proposed rule on Medicare Part B rebilling. And we’ve sued the agency over its policy of denying Medicare claims for necessary services because hospitals provided the treatment in an inpatient rather than outpatient setting. The case is pending before the U.S. District Court for the District of Columbia.

On the legislative front, the AHA is urging Congress to pass the “Medicare Audit Improvement Act,” S. 1012/ H.R. 1250, introduced in the Senate by Sens. Mark Pryor, D-AR, and Roy Blunt, R-MO, and in the House by Reps. Sam Graves, R-MO, and Adam Schiff, D-CA. The legislation is designed to improve auditor performance, increase transparency and permit hospitals to rebill denied claims without unreasonable restrictions.

As the burden to hospitals of increased audit activity and problems with ongoing inappropriate payment denials grows so does support on Capitol Hill for this legislation (see the Hill Head Count on page 5). More than 100 representatives support the House bill because they understand the importance of keeping auditors out of medical decisions and limiting burdensome document requests.

As we recently told the Senate Finance Committee, hospitals recognize the need for auditors to identify billing errors. But the current system – with its avalanche of audits – wastes hospital resources and contributes to growing health care costs.

In a July 8 “AHA Legislative Alert,” we called on hospital leaders to contact their members of Congress and urge them to support S. 1012/H.R. 1250.

As we work to build support for the “Medicare Audit Improvement Act,” please continue to bring examples of overzealous RACs to the attention of your members of Congress. Let them know how leveling the playing field with RACs by passing S.1012/H.R. 1250 will help hospitals back home.

And keep on top of the latest RAC developments by visiting the AHA’s RAC webpage. Just click on: http://tinyurl.com/krtphm4.

Topic: Advocacy and Public Policy

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