Health Information Management

News: AHA supports bill to amend healthcare auditing programs

CDI Strategies, October 25, 2012

Want to receive articles like this one in your inbox? Subscribe to CDI Strategies!

A bill, introduced October 16, aims to curtail the proliferation of healthcare audits and medical requests and improve results of Medicare audit programs. Introduced to the House by Representatives Sam Graves (R-MO) and Adam Schiff (D-CA), the Medicare Audit Improvement Act (H.R. 6575), has roughly a 3% chance of passing, according to govTrack.us. Nevertheless, the AHA penned its support in a letter to House sponsors the same day.

“No one questions the need for auditors to identify billing errors; but the flood of new auditing programs, along with confusing and conflicting regulations, is drowning hospitals with a deluge of redundant audits, unmanageable medical record requests and inappropriate payment denials,” wrote Rick Pollack, AHA’s Executive Vice President.
 
Recent AHA RACTrac data indicates that although hospitals appeal less than half (roughly 40%) of denials, they win those appeals nearly 75% of the time.
 
The proposed legislation offers “much needed guidance for medical necessity audits, keeping auditors out of making medical decisions that should be between patients and their physicians,” Pollack wrote.



Want to receive articles like this one in your inbox? Subscribe to CDI Strategies!

Most Popular