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Medicare Audit Improvement Act introduced in Senate

May 22, 2013

Sens. Mark Pryor (D-AR) and Roy Blunt (R-MO) today introduced a Senate companion to the Medicare Audit Improvement Act (S. 1012/H.R. 1250), legislation strongly supported by the AHA to improve the Recovery Audit Contractor program and other Medicare audit programs. AHA applauded the action and encouraged quick passage by Congress. “Hospitals are inundated with multiple auditing programs (Recovery Audit Contractors, Medicare Administrative Contractors and Comprehensive Error Rate Testing Contractors),” said AHA Executive Vice President Rick Pollack. “These duplicative audits, unmanageable medical record requests and inappropriate payment denials are overwhelming hospitals and diverting resources from patient care. According to an AHA survey, when hospitals decide to commit the time and resources necessary to fight RAC denials in the Medicare appeals process, they are successful at overturning the RAC denial 72% of the time. This legislation provides much needed guidance for auditors while keeping them out of making medical decisions that should be between patients and their physicians. It also will improve recovery auditor transparency and allow denied inpatient claims to be billed as outpatient claims when appropriate.” Reps. Sam Graves (R-MO) and Adam Schiff (D-CA) introduced the bill in the House.