Senate Hearing Spotlights Impact of Hospital Admissions on Seniors


July 30, 2014

Senate Hearing Spotlights Impact of
Hospital Admissions on Seniors

Lawmakers, witnesses discuss profound negative impact of ‘observation status’ on Medicare beneficiaries, underscoring need for greater Medicare oversight

Washington, D.C. – The American Coalition for Healthcare Claims Integrity issued a statement regarding today’s hearing: Admitted or Not? The Impact of Medicare Observation Status on Seniors, held by the U.S. Senate Special Committee on Aging.

“Today’s hearing highlighted a critical issue for seniors,” said Becky Reeves, coalition spokesperson. “Medicare patients held under hospital ‘observation status’ face limited access to long-term care services and greater risk of hospital-born illness – often without knowledge or understanding of these factors. While our coalition agrees that the use of observation status has evolved from its initial intent and administrators should work to clarify these payment policies, the suggestion that the Recovery Audit Contractor (RAC) program has caused this issue is false. The Congressionally mandated RAC program audits less than 2% of Medicare records from any given provider, and only reviews billing issues that have been vetted and approved by the Centers for Medicare and Medicaid Services (CMS), resulting in an average accuracy rate of 95.5%. Integrity contractors have no authority or ability to influence physician’s decisions. Furthermore, the systemic misuse of this admission category demonstrates a need for stronger, more expansive Medicare oversight to ensure greater compliance and promote proper care for patients.

“Medicare currently faces a variety of challenges. According to the Government Accountability Office, Medicare lost $53 billion to waste last year, more than any other federal program and largely due to billing errors by providers. Due to this and other ongoing issues, officials estimate Medicare will be insolvent by 2030. Finally, the testimonies offered today reflect the need for clearer, easy-to-follow payment policies and improved provider education. With a growing number of seniors relying on Medicare for coverage, collaboration among all program stakeholders is imperative to protecting the program’s finite resources. Our coalition appreciates the committee’s effort to place seniors at the forefront of these important discussions, and supports their efforts to minimize wasteful Medicare spending.”

For more information, please visit: www.properpayments.com

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