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AHA briefing highlights RAC overreach

July 26, 2013

Leaders from four hospitals and health systems today briefed congressional staff on the problems they face due to inappropriate payment denials by Medicare recovery audit contractors. Gretchen Case, director of compliance and revenue integrity at Cedars-Sinai Medical Center, discussed the difficulty of explaining to patients why a short-term inpatient stay has been denied by a RAC and the resulting financial consequences the Medicare beneficiary faces. Case explained, “RACs are causing a great deal of uncertainty and expense for hospitals and also for patients. This is money that cannot then be directed toward patient-related care. Furthermore, our patients are either angry or confused when they learn these audits have caused an increase in their out-of-pocket payments or prevented them from qualifying for additional care following their stay in the hospital.” Other hospital and health system participants at the AHA-sponsored event were Steven Hanks, M.D., executive vice-president and chief medical officer of the Hospital of Central Connecticut; John Kerndl, chief financial officer, LifePoint Hospitals; and Don Sipes, vice president for regional services for Saint Luke’s Health System in Missouri and CEO of St. Luke’s North Hospital-Smithville.