Dive Brief:
- Medicare's Recovery Audit Contractor (RAC) program isn't going away, but there might be some changes in how it does business.
- CMS argues that its new "two midnights" rule, which covers only beneficiary stays greater than 48 hours as inpatient admissions, will reduce a lot of the burden hospitals face from the RACs. Some health system leaders are skeptical about this, arguing that the RACs will simply focus on other clinical areas.
- Along with the "two midnights" rule, CMS is promising to "refine and improve" the program. The changes include a 30-day auditor-provider discussion before the claims can be sent to MACs for adjustment. CMS has also revised additional documentation request limits based on a provider's denial rate, with lower limits for those with fewer claims denials.
Dive Insight:
CMS may be trying to get its auditing house in order, but it's going to be a big undertaking. After all, among other troubles, the RACs have an audit backlog that is so long that it's out of compliance with federal law, notes Healthcare Finance News. Hospitals and doctors probably won't be too happy with anything CMS does to tame the RACs, since as they are structured, they're essentially untamable.