Reps. Sam Graves, R-Miss., and Adam Schiff, D-Calif., last night introduced the AHA-supported Medicare Audit Improvement Act, H.R. 2156, which would make several changes to the Recovery Audit Contractor (RAC) program.
The bill would direct the Centers for Medicare & Medicaid Services (CMS) to replace the RAC contingency fee structure with a flat fee to reduce the financial incentive for overzealous auditing practices; rationalize payments to RACs by lowering payments for poor RAC performance; fix CMS’s rebilling rules to allow hospitals to rebill claims when appropriate; and require RACs to base their inpatient claims decisions on only the information the physician had when treating the patient.
“Physicians do what is best for their patients and make medical decisions based on the care needs of their patients,” said AHA Executive Vice President Rick Pollack. “But recovery audit contractors second guess medical decisions and divert resources from patient care. This legislation makes long-overdue repairs to the broken RAC program.”