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AHA Eyes 'Extremely Challenging' 2014

John Commins, for HealthLeaders Media, January 24, 2014

"The RAC program is creating significant strain on the appeals process. Hospitals are the ones bearing the financial burden. There is actually over $1 billion in hospital money caught up in the appeals process and it is taking several years to recapture this full payment for services that were inappropriately denied."


See Also: RAC Appeals Process 'Broken,' AHA Says


Thompson says the AHA supports the bipartisan Medicare Audit Improvement Act of 2013, which would address aggressive RAC behaviors.

Two-Midnight Rule Penalty Delays Sought
The two-midnight rule regulating reimbursements for inpatient admissions went into effect on Oct. 1, 2013, and although hospitals won't be penalized until March, Thompson says AHA wants the Centers for Medicare & Medicaid Services to delay the penalties until at least the end of fiscal 2014.

"Many questions remain unanswered about this policy," she says. "Beneficiaries are unaware of these changes and the impact it will have on them and CMS has not provided any communication to them about this policy."

Nickels says AHA is "very concerned" about the two-midnight rule and is urging Congress to take up the matter too. "We are looking at all avenues, whether it is legislative, regulatory, or legal to try to deal with that issue," he says.


John Commins is a senior editor with HealthLeaders Media.

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