Bloomberg BNA: What Do RACs Think of Hospitals’ Efforts to Change Short-Stay Policies?


Recovery Audit Contractors (RACs) view attempts by providers to change reimbursement levels for short-term hospital admissions as part “of an ongoing effort on the part of the hospital industry to weaken oversight,” a spokeswoman for the American Coalition for Healthcare Claims Integrity (ACHCI), a trade association for the RACs, told me Feb. 17.

The ACHCI comment came in response to a Feb. 13 letter from the American Hospital Association (AHA) that asked the Centers for Medicare & Medicaid Services to reform the RAC program and to provide different payments for some short-term hospital admissions. In its proposed rule for the fiscal year 2016 inpatient prospective payment system, which hasn’t been released yet, the CMS should revise reimbursement levels related to the two-midnight policy, the AHA said in the letter. Under this policy, adopted in 2013, a Medicare beneficiary isn’t an “inpatient” unless the admitting physician expects that beneficiary to need care in the hospital for a period spanning at least two midnights.

The two-midnight rule and other hospital short-stay policies will continue to cause problems for hospitals unless the CMS addresses structural problems with the RAC program “that have resulted in tremendous burden on hospitals and the appeals process,” the AHA letter said.

The ACHCI spokeswoman told me she agreed that “the short stay issue needs to be resolved for all involved.”

However, the group also stressed to me that its members help to save Medicare money and shouldn’t be blamed for doing their job. For example, the ACHCI spokeswoman told me that “Medicare billing errors are on the rise—at an all time high of $46 billion per year—putting the program in a very vulnerable position, with insolvency predicted within the next 15 years.”

Read the full article here.


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