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RAC denials a threat to hospitals and patients

March 20th, 2013

by Kerry Gillespie

From the football coach facing the media after a big game to a mom or dad reviewing with their spouse a parenting decision made in the heat of the moment, no one enjoys being second-guessed.

For doctors and healthcare professional who work in hospitals, however, it is almost an everyday occurrence, thanks to recovery auditors (RACs)--entities that never actually examine a patient.

Since the permanent Medicare Fee-for-Service Recovery Audit Program began in 2009, the amount of reimbursements these contractors have rescinded after services were delivered--services no one has disputed were provided--has grown at a staggering pace.

This type of second guessing goes beyond just questioning a professional decision of a doctor. It has real consequences for patients.

Being second-guessed, by itself, isn't a bad thing, as accountability is important and necessary. What concerns us at Health Management Associates, however, is to see how physicians and our patients and their families are caught up in the unintended consequences of RACs.

For more from HMA's executive vice president of Operations Finance, read the full guest commentary at FierceHealthFinance.


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