Dear Representative Holding:
The undersigned surgical organizations would like to thank you for your leadership in
introducing H.R. 2568, the Fair Medical Audits Act of 2015. This legislation would provide
much needed transparency and due process in the current RAC audit and appeals process.
As you know, the Centers for Medicare and Medicaid Services (CMS) hires Recovery Audit
Contractors (RACs) to identify and prevent improper payments to Medicare providers. There is a
growing concern by many physicians that the lack of accountability has resulted in inaccurate
audit findings and high volumes of appeals. In fact, the Office of Inspector General (OIG) found
that nearly half of the audits that are appealed by providers are overturned by CMS judges in
favor of the provider.
The current lack of transparency in the audit process hampers these “good actors” in Medicare
from understanding their errors and improving their future compliance rates. Providers are
already struggling to adapt to evolving billing and payment rules in the Medicare program, and
the flaws in the audit and appeals process impose additional significant administrative and
financial burdens. H.R. 2568 addresses this lack of transparency and due process in the RAC
audit and appeal process by:
- Enhancing transparency in the audit process to improve compliance;
- Improving the claim review process by requiring RACs to have appropriate knowledge and experience requirements;
- Promoting provider education while increasing RAC accountability for inaccurate audit findings;
…
Read full letter here
