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AHA Sues CMS Over Medicare Reimbursements

John Commins, for HealthLeaders Media, November 2, 2012

Audit Reform Bill Pending
The Medicare Audit Improvement Act of 2012, introduced in the House in October, calls for a number of improvements and financial penalties for—among other things—overturned appeals. The Office of Inspector General has announced plans to examine the Centers for Medicare & Medicaid Services payment policies to hospitals under Part A and Part B next year.

Umbdenstock says AHA supports the legislation in Congress that would curb RAC abuses.

"It tries to bring some balance to the numbers of records RACs can demand at one time and the burdens on hospitals of meeting all of this, which members find so onerous. It puts some boundaries around the process and brings it to a more reasonable level of scrutiny and accountability," he says.

Hatton says the AHA suit is similar to a recent suit settled last week by Medicare beneficiaries that dealt with scope of services. "It has the same basis – that CMS had a policy for which they had no statutory authority that was denying in that case services – in this case for services rendered," she says. "It is very similar... in that there it is a policy based on an absence of statutory authority."


John Commins is a senior editor with HealthLeaders Media.

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