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RAC Appeals Process 'Broken,' AHA Says

Cheryl Clark, for HealthLeaders Media, January 16, 2014

"The system costs too much. We in the healthcare industry are doing the work to address that. But this to me is a blunt-force instrument to accelerate the process in a way that hurts legitimate beneficiaries.

The AHA also wants CMS to:

  • Prevent CMS from recouping disputed funds until after the hospital has received an administrative law judge determination on its appeal.
  • Enforce statutory timeframes during which determinations of appeals must be made, including a required default judgment for the hospital if the appeal isn't heard by statutory deadline.
  • Address systemic issues that lead to avoidable claim denials and provide a mechanism for erroneous denials to be reversed before they get to the appeals process.

In his letters to CMS and Congress, Pollock says CMS should suspend RAC audits "until all levels of the determination and appeals process catch up with their current workloads," allowing time for claims that have already been audited to work their way through the process.


Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
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2 comments on "RAC Appeals Process 'Broken,' AHA Says"


Thomas H (1/16/2014 at 1:48 PM)
This process is a nightmare I know I currently assist the RAC. Most of the high end personal dont have any clue of the process or procedures and seem to be very limited to being open to new structure or any ideas. I have been in the medical billing, collections, administrative field, etc for over 10 years now and the process needs to be fixed starting with the system upgrades and quicker transactions and either removing the sub contractors or requiring them to have a certain amount of personal. I have never been so frustrated or lost at certain times in my field until I ran into this process. I am greatful I have a job but I feel so unproductive because all the incorrect feedback and decision making. Well thats that I hope this process gets fixed quick for the better.

Karen Luther (1/16/2014 at 10:39 AM)
Thank you to the AHA for taking this stand!