RAC Appeals Process 'Broken,' AHA Says
"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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