Florida seniors are concerned about the healthcare debate in Washington and how it could affect them. Even supporters of the president are worried about Medicare cuts, elder care, and drugs and procedures being restricted to them. They paid into Medicare their entire working lives, several said, and basic fairness demands that they be allowed to keep what they have.
President Barack Obama, seeking to rally his base, accused Republican leaders Thursday of trying to block a healthcare overhaul from the start and again threw his weight behind a government-run insurance plan. During a radio call-in show and at a town-hall meeting of supporters, Obama tacked to the left as Democratic allies inched toward trying to pass a healthcare bill on their own.
Some of President Obama's strongest supporters are suggesting that his discipline has slipped as prospects for the passage of healthcare reform becomes murkier. In recent weeks, Obama has delivered mixed messages that have bogged down the debate and sapped momentum from his top domestic priority. Republicans, meanwhile, have stepped into the void of the August congressional recess and, in a page taken directly from Obama's 2008 playbook, are using a combination of online organization and message-of-the-day discipline to frame the legislation as a government takeover.
ECRI Institute, a non-profit patient care research organization, has released a report criticizing the millions of dollars spent on physician preference items, medical supplies ordered primarily because they are preferred by the medical staff. "In order to attain the savings associated with acquisition of physician preference items, hospital leaders need to win the cooperation of the physicians through an evidence-based, value-focused process," said said ECRI COO Anthony Montagnolo in a statement.
CMS created the Recovery Audit Contractor (RAC) program as part of an effort to reduce improper Medicare payments by contracting independent auditors to detect and collect overpayments. The auditors are also charged with identifying underpayments, although during the RAC demonstration phase, about 25 times more overpayments were collected than underpayments paid ($980 million versus $37.8 million).
The demonstration project, which ended its three-year process in March 2008, is the best body of evidence we have to project what the permanent program will be like. The permanent program continues to roll out across the country, with the goal of having all four RAC regions, each responsible for one-quarter of the country, fully operational by 2010. Hospitals and other healthcare organizations interested in preserving their Medicare revenue—including already billed and collected funds—would do well to study the demonstration and learn as much as they can to prepare for a future where RAC audits will soon become an unavoidable reality.
You can do the following to protect your organization from RAC auditors:
Be forewarned. Assessing your risk is an important first step to understanding how big of a problem RAC could be for you. Review historic claims against RAC findings to get a ballpark estimate of how your organization would fare in an audit.
Be efficient. As you build your RAC processes, focus on efficiency in your work flows, reuse documents wherever possible, and always be on the lookout for ways to streamline your processes. New RAC work flow and documentation tools are coming to market now that can help.
Be aware. RAC correspondence is often sent to the hospital's general delivery mailbox, and many organizations are not set up to alert the right people as soon as this occurs. Payment retraction can be halted if FI-level appeals are filed within 30 days and QIC-level appeals within 60, so make sure your staff is trained to spot these letters immediately.
Be persistent. We see no reason not to appeal all the way to the Federal District Court level until standards emerge for what denials will and will not be overturned and why, especially when it comes to large-value claims.
Be consistent. Many billing organizations find themselves torn between clinicians seeking to provide the safest, highest-quality standards of care on one side and RAC auditors making them pay for exceeding basic thresholds of quality on the other. We are working with several organizations to write their own RAC rulebook, setting out well-substantiated standards of care for the organization and using that document to fend off both groups. The idea is to make internal and external organizations prove their case against your evidence.
Editor's note: Bowden is the president of consulting services at ClaimTrust, Inc. She may be reached atkbowden@claimtrust.com. This article was adapted from one that originally appeared in the August 2009 issue of Health Governance Report, a HealthLeaders Media publication.
Senator Charles E. Grassley, an Iowa Republican who has led a long-running investigation of conflicts of interest in medicine, is starting to put pressure on the National Institutes of Health to crack down on the practice of ghostwriting in medical research. The NIH underwrites much of the country's medical research. Many of the nation's top doctors depend on federal grants to support their work, and attaching fresh conditions to those grants could be a powerful lever for enforcing new ethical guidelines on universities, according to the New York Times.