“New Medicare Law to Notify Patients of Loophole in Nursing Home Coverage, the article rightly highlights the role of Recovery Audit Contractors (RACs) -- overzealous government audit contractors -- in the increase in observation status. Their constant second-guessing of physician judgement on short hospital stays is the true cause of the increase of observation stays, which some have depicted in an inaccurate way. 

Allowing RACs to deny the care provided years after the patient was cared for is indefensible, and forced hospitals to be cautious when admitting patients. This is why the Centers for Medicare and Medicaid Services recently took away patient status reviews from the RACs. However, after many abuses and because of the high number of claims denied by the RACs there is a 10-year backlog of appeals as hospitals seek to overturn the inappropriate denials for patient care provided.

The AHA believes that hospitals and practitioners should communicate clearly with patients and their families about their status in the hospital. Providing the best care possible while relying on the sound judgement of physicians is the right prescription for patients. 

Related News Articles

Perspective
The federal government has a history of reimbursing hospitals below of the cost of providing care to patients.For Medicare, which covers more than 60 million…
Headline
Hospitals and health systems are prioritizing preserving access to care for patients in rural America, including via access points like hospital outpatient…
Blog
September is National Suicide Prevention Month, with several days that emphasize the opportunity to elevate awareness about the important role everyone can…
Opinion / Editorial
This Op-Ed originally appeared in The Hill. Will the care be there? A confluence of unprecedented challenges over the last three years, including workforce…
Headline
A recent Wall Street Journal article on hospital divestitures and closures “fails to acknowledge the critical roles that low government reimbursement,…
Headline
The Health Resources and Services Administration has released Maternity Care Target Area weighted scores for Primary Care Health Professional Shortage Areas…