Dive Brief:
- According to the American Hospital Association (AHA), unpaid Medicare claims and a growing number of RAC denials are imperiling its members. The AHA letter implores CMS to change Medicare's claims auditing system.
- In a letter to CMS, the AHA argues that overly aggressive, inappropriate audits and denials of hospital claims have frozen more than $1 billion in Medicare payments. The AHA letter also notes that the RAC appeals process is bogged down in two years worth of backlogs.
- Since 2010, the AHA notes, RAC denials have increased almost 30-fold, and the average number of appeals per hospital has grown from 17 in 2010 to 300 in 2013.
Dive Insight:
In theory, the RAC program saves the government money, catches errors and detects fraud. But in reality, with hospitals winning more than 70% of appealed inpatient denials, the auditing process comes into question. One has to wonder: why are RACs given such free reign to tie up hospital finances if the majority of the cases they bring aren't winners? I'd argue that someone needs to put the RACs on a leash, and soon.