“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

Headline
Virginia hospitals and health systems provided nearly $3.3 billion in community benefit and other support in 2017, according to the latest annual report by the…
Insights and Analysis
The secret to healthy, long lives lies in their social determinants. Six hospitals in a vulnerable area of Chicago pooled resources and ideas to address those…
Insights and Analysis
Adventist Health White Memorial is connecting pregnant women and mothers who live in poverty to the resources and care they need to best support their children…
Insights and Analysis
In this guest column, Kenneth Kaufman, chair of Kaufman Hall, discusses how hospitals need scale to keep pace in today’s environment, as well as continue to…
Headline
AHA today urged the Department of Homeland Security to withdraw a proposed rule that could limit legal immigrants’ future immigration status if they receive…
Insights and Analysis
The University of Mississippi Medical Center and the Medical University of South Carolina have embraced underserved communities with robust telehealth programs…