Support for Medicare Audit Reform

Members of the US Senate Finance Committee, including Sen. Richard Burr (R-N.C.), highlighted a new report from the Government Accountability Office (GAO) detailing inefficiencies with the Medicare Audit and Appeals process and noted a bipartisan Finance Committee bill aimed to reform the process.  The report details a dramatic increase in appeals at the Centers for Medicare & Medicaid Services (CMS), resulting in a backlog at the third and fourth levels of appeals where independent hearings are conducted. The bipartisan bill, Audit & Appeal Fairness, Integrity, and Reforms in Medicare (AFIRM) Act of 2015, S. 2368, would improve many of the deficiencies highlighted by GAO if approved by Congress.

The North Carolina Medical Society (NCMS) has been working closely with Sen. Burr to reform the RAC audit process including NCMS members meeting with Orrin Hatch (R-UT), chair of the Senate Finance Committee. The NCMS produced a video detailing the story of one North Carolina practice devastated by the faulty audit process. Watch the video “Guilty Until Proven Innocent: When Medicare Audits Cause Casualties.”

“Medicare’s audit and appeals processes are clearly not working,” said Sen. Burr. “GAO’s report echoes concerns raised by North Carolinians and is the latest wake-up call for the need for commonsense reforms. We must address the audit and appeals challenges so that doctors and hospitals can focus on what’s most important—providing quality care to Americans. I will keep working with my colleagues to fix this broken system.”

Additional information on the AFIRM Act can be found here. Read the GAO report.

 
 

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1 Comment

  • abu salahuddin, MD, FACP

    RAC is not fair system and they have vested interest in penalizing Doctors and hospitals irrespective of whether they are right or wrong! RAC’s income is tied to the money they recover