AHA urges Congress to enact RAC reforms

The AHA today urged Congress to remove the perverse financial incentives that encourage Medicare Recovery Audit Contractors to deny claims; reduce payments to RACs with a high rate of overturned denials; allow RAC reviews to consider only the medical documentation available when the admission decision was made; and allow hospitals sufficient time to rebill denied inpatient admissions under Part B. The statement was submitted to the Senate Finance Committee for a recent hearing on audit and appeals issues in Medicare. “A statistic that speaks to the impunity and extensive inaccuracy with which RACs deny claims is the finding reported by the Department of Health and Human Services Office of Inspector General that, when hospitals appeal inpatient claim denials to an administrative law judge, they win 72% of the time,” AHA wrote. AHA also voiced strong opposition to a proposal in the president’s budget, discussed during the hearing, that would impose a refundable filing fee on providers at all levels of appeals. AHA said the proposal would “discourage providers from pursuing their statutory rights to appeal denied claims for Medicare payment.”