AMA: Penalize RACs for Overreaching on Medicare Audits

The American Medical Association is vowing to continue fighting Medicare’s incentive policy of giving Recovery Audit Contractors a cut of the payments they get back from providers.


The American Medical Association is vowing to continue fighting Medicare’s incentive policy of giving Recovery Audit Contractors a cut of the payments they get back from providers.

During AMA’s recent policy meeting, its House of Delegates approved a resolution that the association push for penalties and interest to be imposed on an auditor--payable to the physician--“when a RAC audit or appeal for a claim has been found in favor of the physician.”

For your consideration: The Trouble with RACS

The association believes that Medicare’s contingency policy with RACs incents the auditors to overreach, and notes that providers win nearly half of their RAC appeals--at substantial expense to the providers. Consequently, AMA wants RACs to reimburse providers who are successful on appeal.

“The AMA will continue to urge the Centers for Medicare and Medicaid Services to ensure that RACs are more careful with initial overpayment determinations by imposing a meaningful financial penalty on RACs who lose on appeal,” according to the association.

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