Hospitals, auditors clash over RAC reform

Medicare recovery auditors (RACs) are fighting a House bill they say would cut into the billions of dollars in improper Medicare payments recovered by the auditors.

"If you want to send Medicare crashing to the ground, letting improper payments run rampant is a surefire way to do that," Amanda Keating, a spokeswoman for the American Coalition for Healthcare Claims Integrity, told The Hill's Healthwatch.

She noted RACs recovered more than $2 billion in improper payments in 2012 alone, Healthwatch reported.

The American Hospital Association supports the bipartisan Medicare Audit Improvement Act, telling Healthwatch it would relive hospitals of a huge administrative burden and streamline claims that can take up to three years to resolve.

The bill, introduced by Reps. Sam Graves (R-Mo.) and Adam Schiff (D-Calif.), would cap the number of documents RACs can request from hospitals to 2 percent of hospital claims with a maximum of 500 additional document requests every 45 days.

 The number of medical records requested by RACs jumped roughly 10 percent to 720,590 in the fourth quarter of 2012, according to the AHA. In 2011, the Centers for Medicare & Medicaid Services increased the cap on the number of documents recovery auditors could request from hospitals and skilled-nursing facilities.

While the hospital association maintains more than 70 percent of recovery audits are later reversed, CMS says only 2.4 percent of 2010 claims were challenged and overturned, according to Healthwatch.

To learn more:
- read the Healthwatch article
- here's a copy of the bill (.pdf)