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Posted by: Robert Markette However, due to the amounts of money that have been recovered, Medicare is considering expanding the scope of the program. The providers who have been subjected to the current program are, not surprisingly, opposed to it. From Medicares standpoint, a contingency arrangement makes sense, much like an individual with a personal injury claim, if CMS does not get anything, neither does the Auditor. Of course, this overlooks a key point, CMS is not like a person with a personal injury claim. The whole idea behind a contingency fee arrangement is that it provides access to the court for those who might not otherwise be able to afford counsel. CMS has taken it to the next step of hey it allows us to put more auditors out there, without spending more of our budget. But the government has vastly greater resources than the average individual, if they can not afford to pay an auditor by the job, maybe they need to reevaluate their budget. (Of course, I think that a budget is one way the power of an administrative agency is limited.) An audit is supposed to be performed by an independent (and neutral) party according to set standards. When the entity performing the audit is getting paid based upon what it recovers, the party being audited has a legitimate basis to question the neutrality (and integrity) of the auditor and the audit process. It is a fair assumption by the providers that an auditor whose paycheck is dependent upon the amount he recovers may overreach on audits. It is also fair to argue that CMS has chosen this option to provide an incentive to auditors to recover more money. It appears that a large number of appeals have been filed as a result of this process, but Home health line did not mention if the number of appeals was higher than before. If the RAC system allows for more audits, you would expect more appeals, but if the percentage of audit results that were appealed was higher, that could argue in favor of ending the process. If the RAC allows CMS to perform more audits, but more of these audits are appealed, it may cost CMS more in time and money to fight the recoupment appeals than it would to simply hire and pay auditing contractors. Similarly, if a larger percentage of the appeals are successful, this could raise some serious questions about the fairness of the process and overreaching by auditors. Ultimately, CMS should be just as concerned about providing an audit that is fair in substance and appearance. The RAC program, regardless of its intentions and goals, sends all the wrong message to the provider community and creates an audit process that leaves providers feeling that CMS is out to get them. The RAC program should be stopped and CMS and Congress should think harder about what the term audit actually means. Because this program comes up for review when Congress reconvenes, providers and state associations should keep an eye out and be prepared to contact their representatives, to make sure the RAC process stays out of home health and hospice. Home health and hospice providers have enough to deal with already. |
NewsHealth Care
[08/15] Catalyst Pharmaceutical Partners Reports Second Quarter 2008 Financial Results Topics
Adminstrative Law Recent UpdatesJuly 18, 2008 May 29, 2008 May 28, 2008 May 13, 2008 May 08, 2008 ArchivesWeb ResourcesFindLaw |
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The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for individual advice regarding your own situation. Copyright © 2008 by Home Care Law Blog Gilliland & Markette LLP. All rights reserved. You may reproduce materials available at this site for your own personal use and for non-commercial distribution. All copies must include this copyright statement. | |
