Hospitals urge OIG to investigate RACs

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The American Hospital Association continues to ratchet up its pressure on recovery auditors (RACs), asking federal regulators to halt all inappropriate denials of payments made by RACs and to streamline all existing integrity programs, reported AHA News Now.

The hospital group claimed recovery auditors are "often wrong" but not penalized for being so, according to a letter sent last week to U.S. Department of Health & Human Services Inspector General Daniel R. Levinson by AHA Executive Vice President Rick Pollack. The AHA cited its own survey data, concluding that 75 percent of RAC denials are overturned when appealed.

"The AHA believes that the RAC audit process would improve significantly if auditors were required to improve their accuracy or face financial penalties," Pollack wrote. "In addition, RACs should be prohibited from issuing medical necessity denials, which invalidate the medical judgment of a trained healthcare professional and force hospitals into the costly and complex Medicare appeals process."

Pollack called for the OIG to investigate the issue, Long-Term Care News reported.

Moreover, Pollack noted in his letter that overlapping and duplicative efforts among RACs and other CMS contractors overwhelm providers. "For example, RACs, MACs and ZPICs are all charged with reviewing hospital Medicare claims, and hospitals may be required to respond to simultaneous audits of the same claims or to duplicative record requests. These redundant audits drain time, funding and attention that could more effectively be focused on patient care," he wrote.

Earlier this month, the AHA and its member hospitals threw their support behind a bill they say would improve auditing programs by limiting medical record requests, creating financial penalties and requiring medical necessity audits focus on widespread payment errors, FierceHealthcare previously reported.

For more information:
- read the AHA News Now news brief
- read the Long-Term Care News article
- check out the AHA letter (.pdf)

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