Given the significant financial pressures facing our federal government and with the health and economic security of nearly 48 million American seniors on the line, Congress must act now to authorize CMS to review Medicare claims before they are paid and finally put an end to the rampant wasteful spending within the program.
Angry lawmakers ripped an overwhelmed Medicare appeals process that has wilted under a tenfold increase in audits recently. Federal officials from two key agencies agreed that the Medicare’s Recovery Audit Contractor (RAC) program needs to be revised.
Aspects of the Medicare Recovery Audit Contractor program came under intense scrutiny during a Senate Finance Committee hearing in June. Lawmakers questioned auditor payment incentives and a sluggish appeals process.
Here’s the good news for providers: new analytics are making it possible to understand and bill your care in ways that would have been impossible just a few years ago. Here’s the bad news: The government is quite aware of these new options.
Skilled nursing facilities accounted for only about $200,000 of $797 million in collected Medicare overpayments in 2011 identified by Recovery Audit Contractors, according to an annual audit report released Tuesday.
A major hospital group has called for a federal investigation into mistakes made by recovery audit contractors. “Numerous inaccuracies” often result in improperly denied payments and decisions that go unpenalized, laments a letter sent by an American Hospital Association leader.