Hospitals: Medicare auditing unfair but effective
Most hospitals feel the U.S. government’s healthcare agencies treat them unfairly when auditing their Medicare claims but, by an even wider margin, they admit that the auditing process does what it’s supposed to do. Those are among the standout conclusions of a survey by Ivans, a healthcare consulting firm based in Stamford, Conn.
Of the 128 hospitals from across the U.S. that responded to its June survey, 73 percent agree that the Recovery Audit Contractor (RAC) program helps reduce fraud and errors in the system. Still, more than 60 percent think the audit process is too subjective.
Responding hospitals voiced their objections to the strains placed on thin budgets by the time and money it takes to substantiate a RAC claim. They also feel the frequency at which they can be audited, every 45 days, unnecessarily burdens administrators.
Some 44 percent cited “increased administrative costs to manage responses to RAC audit requests and/or appeals,” while 38 percent said they have modified admission criteria to reduce RAC audit denials in the future. Meanwhile, 21 percent of the respondents said they have “hired more staff or external resources to support additional administrative responsibilities of clinical staff to respond to RAC audits.”
Ivans pointed out that Department of Health and Human Services’ Centers for Medicare & Medicaid Services (CMS) recently implemented a program to allow electronic submission of medical documentation from providers. Ivans counts hospitals looking to take advantage of this program, designed to improve accuracy and efficiency, among its customers and prospects.
Medicare’s RAC program was made permanent in all 50 states by the "Tax Relief and Health Care Act of 2006." It was mandated to identify underpayments as well as overpayments, although CMS has reported that the overwhelming majority of erroneous claims—96 percent between 2005 and 2008—are for overpayments.
Of the 128 hospitals from across the U.S. that responded to its June survey, 73 percent agree that the Recovery Audit Contractor (RAC) program helps reduce fraud and errors in the system. Still, more than 60 percent think the audit process is too subjective.
Responding hospitals voiced their objections to the strains placed on thin budgets by the time and money it takes to substantiate a RAC claim. They also feel the frequency at which they can be audited, every 45 days, unnecessarily burdens administrators.
Some 44 percent cited “increased administrative costs to manage responses to RAC audit requests and/or appeals,” while 38 percent said they have modified admission criteria to reduce RAC audit denials in the future. Meanwhile, 21 percent of the respondents said they have “hired more staff or external resources to support additional administrative responsibilities of clinical staff to respond to RAC audits.”
Ivans pointed out that Department of Health and Human Services’ Centers for Medicare & Medicaid Services (CMS) recently implemented a program to allow electronic submission of medical documentation from providers. Ivans counts hospitals looking to take advantage of this program, designed to improve accuracy and efficiency, among its customers and prospects.
Medicare’s RAC program was made permanent in all 50 states by the "Tax Relief and Health Care Act of 2006." It was mandated to identify underpayments as well as overpayments, although CMS has reported that the overwhelming majority of erroneous claims—96 percent between 2005 and 2008—are for overpayments.
Dave P. has worked in journalism, marketing and public relations for more than 30 years, frequently concentrating on hospitals, healthcare technology and Catholic communications. He has also specialized in fundraising communications, ghostwriting for CEOs of local, national and global charities, nonprofits and foundations.