RAC battles move forward

The debate over whether Recovery Audit Contractor audits are an incentive-laced system of provider harassment or a necessary tool to redistribute misspent Medicare funds continues. Neither side appears to be backing down.

The American Hospital Association, representing both acute and post-acute care providers, has blamed incentive-guided contracted auditors for causing a “tremendous burden on hospitals and the appeals process.” Besides calling for more favorable short-stay reimbursements, the AHA and other provider groups want the federal government to reform the RAC program as a solution to a backlog of more than 800,000 Medicare appeals cases.

RAC contractors earn commissions on improprieties found.

The Council for Medicare Integrity, a contractor advocacy group, contends Medicare billing errors have reached an unprecedented $46 billion per year, which, it says, could make the Medicare program insolvent by 2030. The group called the AHA's request an attempt “to weaken oversight.”

The RAC auditor group recently changed its name from the American Coalition for Healthcare Claims Integrity to symbolize the evolution “from an exclusive focus on advocacy to reflect new offerings and a partnership with Medicare stakeholders who share a commitment to fighting waste in this important program.

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