The American Hospital Association is welcoming a decision from the HHS Office of Inspector General to review the effectiveness of various Medicare contractors, including the Recovery Audit Contractors program.
The review is in IOG’s workplan document for fiscal 2013. “These programs auditing payment accuracy are well intentioned; no one questions the need for auditors to identify billing mistakes,” AHA notes in a letter to Inspector General Daniel Levinson. “But hospitals continue to be frustrated with the RACs’ considerable inaccuracy in determining whether the hospital received any overpayments.” They also are overwhelmed by the significant overlap and duplication of efforts among the RACs and CMS’s other contractors.”
The support for the OIG review comes days after AHA endorsed legislation introduced in the U.S. House to revamp the RAC program. RAC contractors are paid on a contingency fee basis, which is a potential conflict of interest, and hospitals experience significant amounts of denials but successfully appeal 75 percent of them, according to the association.
In the letter to Levinson, AHA asks that OIG pay particular attention to the extent to which RAC determinations result in inappropriate denials for payment. “In addition, we urge that all integrity programs be streamlined and duplicative audits eliminated. Finally, we suggest that additional investments be made in provider education and payment system fixes to prevent payment mistakes before they occur.”
Text of the four-page letter to Levinson, with another 70 pages of supporting documentation, is available here.
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