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Senate Finance Committee examines oversight of RACs

June 25, 2013

Testifying before the Senate Committee on Finance today, representatives from Billings (MT) Clinic and Salt Lake City-based Intermountain Healthcare urged the government to do a better job overseeing Recovery Audit Contractors. J.J. Carmody, director of reimbursement at Billings Clinic, and Suzie Draper, vice president of business ethics and compliance at Intermountain Healthcare, said their organizations are very successful overturning RAC denials on appeal, but must spend significant financial and staff resources to manage the audit and appeals process, which might otherwise be applied to quality improvement and patient care. In a statement to the committee, AHA voiced its support for the Medicare Audit Improvement Act (S. 1012/H.R. 1250). Among other provisions, the bill would establish a consolidated limit for medical record requests, impose financial penalties on RACs that fail to comply with program requirements, make RAC performance evaluations publicly available and allow denied inpatient claims to be billed as outpatient claims when appropriate.