Providers push for audit improvements

Hospitals are throwing their support behind a bill that they say would improve the recovery auditor program and other national audit programs, AHA News Now reported.

The bill by Reps. Sam Graves (R-Mo.) and Adam Schiff (D-Calif.) would limit medical record requests, create financial penalties and would require medical necessity audits to focus on widespread payment errors, among other changes.

In a letter praising the bill, the American Hospital Association argued that "redundant" government auditors are not only wasting hospital resources but also driving up healthcare costs.

"No one questions the need for auditors to identify billing errors, but the flood of new auditing programs, along with confusing and conflicting regulations, is drowning hospitals with a deluge of redundant audits, unmanageable medical records requests and inappropriate payment denials," AHA Executive Vice President Rick Pollack wrote in the letter.

Under the bill, physicians would have to review Medicare denials. According to the AHA, that would give "much-needed" guidance for determining medical necessity, a RAC audit hotspot. Medical necessity decisions should be kept between patients and their physicians, the AHA wrote.

Support for the proposed legislation follows a letter to the editor earlier this month, in which the AHA argued that billing mistakes aren't equivalent to healthcare fraud. So-called "EHR abuse" stems from a huge increase in government audits and highly complex payment rules--not necessarily providers gaming the system by upcoding and cloning records, the AHA said.

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