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RAC Nightmare Continues for Providers

Rene Letourneau, for HealthLeaders Media, September 16, 2013

Karen Testman, senior vice president of financial operations at MemorialCare Health System, agrees with the concept of reducing Medicare overpayments, but takes issue with the administrative work it creates for providers.

The goal of CMS's Medicare Recovery Audit Contractor program is to identify and correct overpayments—and, to be fair, underpayments—made on claims for healthcare services provided to Medicare beneficiaries. That sounds good in theory, given that the government can hardly afford to waste billions of dollars on care that isn't necessary.

Yet, as with most things, theory is a far cry from reality, at least in the eyes of many hospitals and health systems.

Karen Testman, senior vice president, financial operations at MemorialCare Health System, a six-hospital institution based in Long Beach, CA, says that while she agrees with the concept of reducing Medicare overpayments, the administrative work it creates for providers is a "nightmare."

"As a taxpayer, I can certainly understand that you don't want someone abusing the system so that the government is paying for a fraudulent situation or claims they shouldn't be paying, but [RAC auditors] are getting into arguing about medical necessity, and we get caught in the middle," she says.

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3 comments on "RAC Nightmare Continues for Providers"


Jeff Angel (9/23/2013 at 8:17 PM)
This will continue until organized medicine makes a stand. I dont know why we are cowering down to cms and auditors over this blatant money grab from hard working people. We all need to just say no!!!!!! MPHs need to help us figure this out[INVALID][INVALID]penalizing hard workers with post audits when we dont know rules is one of yhe most stressful things in medicine. Another reason for smart kids to go into medicine. If we have surgeons in 20 years it wi be a miracle!!!!!

Ronald Hirsch (9/19/2013 at 2:53 PM)
RAC's claim they are fighting fraud and that RACTrac data is faulty and self-selected http://goo.gl/Yf6GJU yet they have only found 8 cases of fraud in 7 years. Irony at its best

daniel dulnikowski (9/16/2013 at 8:20 PM)
We were hit with three a few months ago. Two Breast Cancer patients, and an Ovarian Cancer patient. All had Lymphedema, and needed compression pumps. I looked and the paperwork and it was all solid. One had already be fought to the ALJ level, and won. We submitted our paperwork, and LOST. Two of these patients shoudl be covered under the Women's Cancer Health Act of 1998. But they were denied anyway. If they can do it to these patients, they can do it to anybody.