Guest Columns

What's in a name?

Tara Roberts
Tara Roberts

After hearing about the American Coalition for Healthcare Claims Integrity changing their name I couldn't help but laugh and revisit my “Fuzzy Math” guest column, where I questioned this group's conclusive evidence that RACs determinations have a 95% accuracy rate. 

I discussed how while the group talked about how Recovery Audit Contractors were "saving the Centers for Medicare & Medicaid Services billions," they also discussed that RACs were accurate 95% of the time. 

My problem, then and now, is that their group has the word "Integrity" in its title, but that RAC determinations don't have a functioning appeals process that is active, compliant, accountable and validated.”

The new name of this group is The Council for Medicare Integrity. Wow — significant change, right? Many say this is the group's effort to “reach across the aisle” to providers while shifting focus off their main agenda (advocating for RACs) and joining forces with stakeholders to fight waste together.

I visited their new website www.properpayments.org and BAM, in your face, “Medicare loses over $40 billion due to improper payments every year.” Long-term care providers should not be fooled. The agenda is not changed, only the name.  

I encourage you to visit www.journalofhospitalmedicine.com and read the original research “Recover Audit Contractor Audits and Appeals at Three Academic Medical Centers." It's a delightful read with no “Fuzzy Math”. 

The President's budget plan provides funding for needed RAC reform. The Council for Medicare Integrity will NOT be making nice with LTC providers to seek reform. They WILL continue to fiercely advocate for RACs and their “fuzzy math” successes which will not be truly vetted out until the backlog is relieved, and we have the results of RAC denied claims taken to the ALJ.

What will RAC reform look like? That is yet to be seen: Many proposals are just as scary as the current system and issues we already have on our plate. 

If any entity needs to make a name change, it's "RAC." But I suggest the contractors can keep the same name, just start recognizing they are “Reckless And Careless."

Tara Roberts, PT, is the Vice President of Rehabilitation and Wound Care Services at Nexion Health.

Guest Columns

Guest columns are written by long-term care industry experts, ranging from academics and thought leaders to administrators and CEOs.

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