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Recovery Audits Targeted by House Bill, AHA Suit

James Carroll, for HealthLeaders Media, November 9, 2012

Mackaman agrees, adding that an OIG review of the RAs is appropriate.

"Currently the OIG is reviewing the Medicare and Medicaid contractors, so why not the RAs, who are in effect a contractor under CMS—both reviewing pre-and post-payments?" she says. "Any entity that is charged with paying, auditing, or recovering Medicare funds should be scrutinized for how well they are complying with the program's regulations.

"Without being under the watchful eye of the OIG, we enter into a ‘wild west' state where the providers and Medicare contractors are under review but the RAs can do as they please, only to be challenged by providers [willing to appeal], which is very costly endeavor even when the providers are winning 75% of the appeals."

With the pressure now put onto the federal government and the RAs, it is unclear what their next move will be, but certainly these efforts have garnered national attention. If nothing else, the totality of the AHA's actions has highlighted the fact that RAs cause significant administrative and financial strain on facilities—whose main objective is to provide quality patient care—and that some modification of the existing programs would only benefit providers, says Mackaman.

"Healthcare is probably the only business I am aware of that is getting paid less today with more overhead costs to operate an increase in business while still managing to keep  their doors open," she says. "Under the current system, we are dealing with a house of cards and the RAs are adding to that tremulous structure."


James Carroll is associate editor for the HCPro Revenue Cycle Institute.
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