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Ted Shaw Blog
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Encourage your legislators to restore fairness

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Last week, I encouraged you to meet with your members of Congress when they are home this month for the district work period. I suggested that you speak with them specifically about supporting legislation to reform the Medicare readmissions penalties program. HR 4188 and S 2501 are both important pieces of legislation that would go a long way towards making the Medicare readmissions reduction program more fair and less punitive of hospitals that serve a disproportionate number of vulnerable patients.

Restoring fairness is also the theme of another piece of legislation before Congress. HR 1250 and its companion Senate legislation (S 1012) would provide much-needed reform of the Medicare Recovery Audit Contractor program. Although originally well-intentioned to combat fraud and abuse, RAC audits have become increasingly burdensome and costly for hospitals and are ultimately inefficient. The overwhelming majority of RAC-denied claims are eventually overturned in favor of the hospital but not before the hospital has spent precious time and financial resources appealing the denial. Compounding the ineffectiveness is the unfairness of allowing RACs to audit up to three years of claims but hospitals to rebill for denied services only for the past year. This inequity means that if the RAC decides that an inpatient service from 18 months ago should have been provided and billed on an outpatient basis, the hospital cannot rebill the charge.

It is important that members of Congress hear directly from you about the financial and human resource cost associated with RAC audits. Explain to them that while you take seriously your obligation to properly bill for the services provided to Medicare beneficiaries, the RAC audit process has become aggressive in its reach and tactics and is in need of reining in.

The RAC reform bills have a growing number of cosponsors; at last count there were 227 members of the House, including 22 from Texas, and 16 senators signed on. However, there are several Texas members who have not yet signed on and who serve on the House Energy and Commerce Subcommittee on Health and the Senate Finance Committee to which the bills have been referred. These include Reps. Burgess and Barton and Sen. Cornyn.

More information on the RAC program and its impact on hospitals are available from THA. Let’s make sure our elected lawmakers hear from Texas hospitals this month about restoring fairness.

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