Senate Roundtable and Report Examine Ways to Improve Medicare Integrity


July 9, 2014

Senate Roundtable and Report Examine
Ways to Improve Medicare Integrity

Discussion clarifies misconceptions about the Recovery Audit Contractor (RAC) program

Washington, D.C. – The Senate Special Committee on Aging today held a roundtable discussion about Medicare auditing, including the Recovery Audit Contractor (RAC) program, used to review Medicare claims, identify billing errors and recover misused funds. The participants included Chad Janak, Vice President, Audit Operations, Connolly Healthcare, Kathleen King, Director, Healthcare, Government Accountability Office, and other Medicare stakeholders.

“Communication leads to collaboration,” said Becky Reeves, spokesperson for the American Coalition for Healthcare Claims Integrity (ACHCI). “Our coalition applauds the Aging Committee for fostering this important discussion about how to improve Medicare oversight and reduce improper payments on behalf of seniors and taxpayers.”

Following a Congressional mandate to combat widespread Medicare waste, the Centers for Medicare and Medicaid Services (CMS) launched the national RAC program in 2009. In five years, RACs have returned over $8 billion to the Medicare Trust Fund, and over $700 million to providers, while reviewing less than 2% of Medicare claims.

In her comments, King clarified several key misconceptions about the RAC program, including:

  • The current RAC program statement of work expressly prohibits RAC contractors from educating providers beyond sharing information about the outcome of its audits. Rather, that function is fulfilled by Medicare Administrative Contractors (MACs).
  • CMS thoroughly reviews and approves all topics to be audited by its contractors before they conduct any post-payment reviews.
  • RACs are subject to greater oversight than all other Medicare contractors, and CMS could potentially benefit from expanding these requirements to other auditing programs.

In addition to the roundtable, the committee also released a report examining Medicare auditing programs.

“Our coalition appreciates the committee’s review of Medicare integrity initiatives and the RAC program,” said Reeves. “This report states explicitly that RACs have returned significant funds to the Medicare Trust Fund and providers, while being subject to greater oversight than all other Medicare contractors. However, the report also notes that existing educational efforts overseen by MACs are insufficient, that Medicare appeals data is often inconsistent or incomplete, and that the variance in CMS requirements for different types of contractors has lead to provider confusion and inefficient program operations. In light of these findings, we agree with the committee’s recommendations to improve provider education, streamline program requirements and enhance data and reporting mechanisms. Together, these measures will promote greater compliance and transparency, and serve as proactive steps toward reducing improper payments.”

The Aging Committee’s focus on this issue comes at a critical time for Medicare. In March, Congress passed the Protecting Access to Medicare Act, which severely limits the scope of the RAC program until March 2015, while CMS implements new provider reimbursement policies. In addition, CMS has yet to award the next round of RAC program contracts, despite the previous contracts ending June 1, 2014. Due to this delay, RACs are currently not conducting any post-payment reviews. Combined, these ongoing constraints on program oversight will cost the Medicare Trust Fund at least $5 billion in unrecovered improper payments.

“All integrity programs benefit from ongoing evaluation and refinement,” said Reeves. “Following today’s roundtable and report, our coalition hopes all Medicare stakeholders can continue to work together to promote billing accuracy and prolong Medicare’s solvency.”

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

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