House Members Urge HHS to Reform RAC Program

More than 100 House members have asked HHS Secretary Kathleen Sebelius to take immediate action to reform the Medicare recovery audit contractor program, according to an AHA News report.

In a letter to Ms. Sebelius, the 111 legislators wrote RACs have "imposed a huge administrative burden on hospitals, which must spend valuable time and resources to appeal denied claims." According to the House lawmakers, the need for reform is further illustrated by the recent Office of Medicare Hearings and Appeals' December 2013 announcement of a temporary suspension of most new requests for administrative law judge hearings concerning payment denials from RACs.

Most new hearing requests will be delayed by at least two years. Last month, the American Hospital Association urged CMS to work with OMHA to address the suspension to mitigate detrimental effects for hospitals.

In their letter, the House lawmakers "strongly recommend" that CMS use additional resources to resolve the backlog of appeals that necessitated the suspension of new requests. They also urged the agency to implement other reforms "to ensure that auditors are charged with identifying real claim coding and medical documentation errors, as well as provide a more transparent mechanism through which providers can be informed of errors so as to avoid them in the future."

Since the RAC program launched in late 2009, it has recouped more than $5.4 billion from healthcare providers. According to the American Hospital Association's Web-based RACTrac survey, RAC activity has been rising.

More Articles on Medicare RACs:
3 Key Articles on Medicare RACs
Coalition Asks HHS to Reform Medicare RAC Appeals Process
AHA Urges Congress, CMS to Address Medicare RAC Appeals Suspension 

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