RACs push back against audit improvement bills

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Bill would limit Medicare claim reviews for trusted providers
Bill would limit Medicare claim reviews for trusted providers

An advocacy group for independent Medicare auditors has sharply criticized two bills that would put new controls on Recovery Audit Contractors.

The Medicare Audit Improvement Act of 2013 was introduced in the House of Representatives in March. A Senate version of the bill was introduced last month. The bill would rein in auditors and improve transparency, which have been provider concerns. The goal is for less redundant audits, less burdensome and unreasonable requests for records and less inappropriate payment denials. Providers also have blasted the RAC fee structure, which rewards the auditors for identifying errors.

The American Coalition for Healthcare Claims Integrity, a group representing RACs, said the bills would “hamstring” the auditors and allow waste, fraud and abuse to proceed unchecked.

“We have a situation here where Congress is beholden to big industry instead of the American taxpayers,” said coalition spokesperson Amanda Keating.

Medicare improperly paid out more than $65 billion in 2012, Keating said. She stressed that RACs have discovered egregious abuses of the Medicare program, “tantamount to the government buying $600 toilet seats.”

The coalition released its statement Monday. The next day, the American Hospital Association released its RACTrac Survey for the first quarter of 2013. Medical records requests were up 53% year-over-year, the survey showed. Hospitals appealed 44% of RAC denials, with a 72% success rate.

Click here to access the full coalition statement.

Click here to read the full text of the Medicare Audit Improvement Act.

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