RACs Raise Concerns About Suspension of Medicare Claims Reviews


October 16, 2013

CONTACT: Kristin Walter
(202) 898-0995

RACs Raise Concerns About Suspension
of Medicare Claims Reviews
Coalition highlights devastating financial impact of new rule, points to auditors’ high accuracy rate


Washington, DC – Members of the American Coalition for Healthcare Claims Integrity (ACHCI) voiced concerns today about the new “two-midnight” rule for inpatient admissions issued by the Center for Medicare and Medicaid Services (CMS). CMS has used implementation of this rule to suspend audits of short inpatient hospital claims from October 1, 2013 until January 2014.

The CMS Recovery Audit Program, which reviews and corrects hospital-billing errors, has successfully recovered more than $7 billion in improper Medicare payments since the program began in 2009. This auditing interruption will amount to an estimated loss of $1 billion in potential recoveries for Medicare, or more if the delay extends beyond January.

“The potential loss is staggering, and the delay is troubling because the audit recovery program has proven to be one of the most effective ways to address erroneous payments and return dollars to Medicare,” said coalition spokesperson, Kristin Walter.  “Auditors work with hospitals and CMS to not only ensure proper payments for Medicare, but also to educate providers about how to enact appropriate controls, identify gaps in payment processes and avoid future Medicare billing issues.”

The American Hospital Association’s (AHA) recent complaints about the Recovery Audit program have put increasing pressure on CMS to weaken the Recovery Audit Program, despite government data that demonstrates the precision of RAC findings – with an average accuracy rate of 95 percent.

“The Recovery Audit Contractor program is one of the government’s few successful initiatives to identify and recover waste, fraud and abuse in Fee-for-Service Medicare,” said Thomas Schatz, President of the taxpayer watchdog group Citizens Against Government Waste.  “The highly effective RAC oversight program has saved billions of taxpayer dollars and helped to extend the life of the Medicare Trust Fund.”

“It is the responsibility of hospitals to ensure they are providing proper care to patients while fully complying with Medicare billing policies,” said Walter.  “We will continue to work with providers and program administrators to ensure the delivery of high-quality care at the highest value for the 50 million Americans who rely on Medicare benefits every year.”

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

# # #

  • Share

Comments are closed.