AHA urges against hospital RACs for Medicare Advantage

Hospitals are urging the Centers for Medicare and Medicaid Services to not start up a recovery audit contractor program for Medicare Advantage plans, reports AHA News Now.

A Feb. 23 letter sent by AHA Executive Vice President Rick Pollack to CMS Administrator Donald Berwick claims the establishment of such a program would duplicate current efforts. The Patient Protection and Affordable Care Act requires some form of auditing of the Medicare Advantage program.

"Hospitals already work with Part C Medicare Advantage plans to identify billing mistakes and repay inappropriate payments," Pollack says in his letter. "As you know, Medicare Advantage plans are at risk for any improper Medicare reimbursements made to providers; therefore, they have a strong financial incentive to ensure billing mistakes do not occur." As a result, most plans already have extensive auditing programs in place.

Instead, Pollack advises CMS to focus on auditing payments made directly from Medicare Part C to the Medicare Advantage plans. "Audits should review whether per member, per month payments are for the correct Medicare beneficiaries, enrollments and disenrollments are accurate, and plan information provided to CMS is correct."

Pollack's letter was part of the public comments submitted to CMS on the new RAC proposal.

For more:
- read the AHA News Now article
- read Pollack's letter (.pdf)