Dive Brief:
- A new bill before Congress would curb practices by Recovery Audit Contractors (RACs) that some hospitals say are costly, overly burdensome and in some cases, even abusive.
- The Medicare Audit Improvement Act of 2015 has gained bipartisan support in the House since its introduction in April.
- The bill would eliminate financial rewards for claim denials; instead, RACs would be paid a flat fee.
Dive Insight:
The RAC program has been rough on hospitals. "Physicians do what is best for their patients and make medical decisions based on the care needs of their patients," American Hosptital Association Executive Vice President Rick Pollack said in a statement. "But recovery audit contractors second guess medical decisions and divert resources from patient care."
According to HealthLeaders Media, the bill would:
- Reduce payments to RACs that are inaccurate in their audit findings
- Amend rules to allow hospitals to rebill claims when appropriate
- Require RACs to make inpatient claims decisions using the same information the physician had when treating the patient
The bill has not yet been scored by the Congressional Budget Office. In 2013, RACs recovered around $3.75 billion in "faulty" medical claims. If the bill will affect that revenue, legislators would have to come up with a way to offset the loss.