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AHIMA supports proposed legislation to improve current audit program

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CHICAGO – March 19, 2013 – The American Health Information Management Association (AHIMA) supports the Medicare Audit Improvement Act of 2013 introduced to Congress today.  The proposed legislation, co-sponsored by Representatives Sam Graves (MO-R-6th) and Adam Schiff (CA-D-29th), will address critical operational problems that exist with the Medicare Recovery Audit Program and ensures that Medicare recovery auditing is efficient, transparent and fair.

“Health Information Management (HIM) professionals are deeply involved in the collection of the health data that is the subject of the recovery audits, making them the point of contact for responding to the various and numerous audit requests,” said AHIMA CEO Lynne Thomas Gordon, MBA, RHIA, CAE, FACHE, FAHIMA. “Although our members agree that it is important to review, audit and identify improper Medicare payments, the process has become overly burdensome and ineffective as evidenced by the high percentage of successful appeals.”

Under the present program, Recovery Audit Contractors (RACs) are private organizations that contract with the Centers for Medicare and Medicaid Services (CMS) to identify and collect improper payments made in Medicare’s fee-for-service (FFS) program.  Although RACs have had success in recouping improper payments, RAC determinations have also resulted in thousands of errors and have been frequently overturned through costly appeals processes. Hospitals and healthcare systems are inundated with redundant audits, unmanageable medical record requests and inappropriate payment denials.  Thus, the inefficiencies of the program result in wasted resources and directly contribute to the increase in healthcare costs.

“We don’t oppose audits – they provide needed checks and balances to achieve quality healthcare through quality information,” said Thomas Gordon.  “However, the existing RAC program is broken and needs immediate changes.”

The Medicare Audit Improvement Act of 2013 would:

    Establish a consolidated limit for medical record requests;
    Improve auditor performance by implementing financial penalties and by requiring medical necessity audits to focus on widespread payment errors;
    Improve recovery auditor transparency;
    Allow denied inpatient claims to be billed as outpatient claims when appropriate
    Require physician review for Medicare denials.

On March 19, AHIMA members will deliver important advocacy messages that affect patient health information during its annual Hill Day. This year’s agenda will include seeking support for the Medicare Audit Improvement Act. Since most healthcare providers are affected by the current RAC process, AHIMA members will meet with their local representatives in Washington, D.C., to explain the merits of the proposed legislation.


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