In the one-page advertorial, AHA President and CEO Rich Umbdenstock said there are four separate federal programs that “conduct redundant reviews” of hospital payments to identify and false claims or improper billing patterns.
“If Recovery Audit Contractors believe a patient should have been treated in an outpatient facility rather than being admitted, the hospital must return payment — even if everyone agrees the care was necessary,” Mr. Umbdenstock wrote. “Hospitals prevail at least 75 percent of the time when they appeal these decisions, but each appeal costs even more time and money that could go to patient care.”
Mr. Umdenstock also pointed to federal and legal scrutiny over hospital-physician relationships, something he said stifles improvements to care coordination.
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