Senate committee approves RAC overhaul bill

Sen. Ron Wyden (D-OR), Finance Committee ranking member
Sen. Ron Wyden (D-OR), Finance Committee ranking member

The Senate Finance Committee has approved legislation aimed at changing how improper Medicare payments are handled by Recovery Audit Contractors, and also easing the backlog of claims received by the Office of Medicare Hearings and Appeals.

The proposed Audit & Appeal Fairness, Integrity, and Reforms in Medicare Act of 2015 creates new resources and incentives for the Department of Health and Human Services in order to streamline the auditing process and keep up with the increasing number of appeals received by OMHA. Currently OMHA can process 77,000 appeals annually, a number that falls drastically short of the 474,000 appeals the office received in 2014.

The bill, which was passed Wednesday, would allow HHS to hire more people to process backlogged claims, and fast track lower-cost, less-complex claims by giving them to a separate set of hearing officers for consideration. It also requires the Centers for Medicare & Medicaid Services to better coordinate provider audits, and to create an ombudsman position to increase transparency and efficiency.  Providers who consistently bill correctly will also be exempted from certain audits.

“It's important to remember that behind each case is a patient paying out-of-pocket while their appeal is being considered, or a provider who would rather focus on giving care than dealing with billing issues,” committee ranking member Sen. Ron Wyden (D-OR) said in a statement.