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AHIMA: Medicare Recovery Audit Legislation is Needed

March 20, 2013
by Gabriel Perna
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The American Health Information Management Association (AHIMA) has announced its support for the Medicare Audit Improvement Act of 2013, which it says would address critical data related operational problems to the Medicare Recovery Audit program.

“Health Information Management (HIM) professionals are deeply involved in the collection of the health data that is the subject of the recovery audits, making them the point of contact for responding to the various and numerous audit requests,” AHIMA CEO Lynne Thomas Gordon, said in a statement. “Although our members agree that it is important to review, audit and identify improper Medicare payments, the process has become overly burdensome and ineffective as evidenced by the high percentage of successful appeals.”

The current recovery audit program, AHIMA says, relies on third party organizations called Recovery Audit Contractors (RACs), and creates a system that inundates hospitals and healthcare systems with redundant audits, unmanageable medical record requests and inappropriate payment denials. The legislation, introduced by Representatives Sam Graves (MO-R-6th) and Adam Schiff (CA-D-29th), would establish a consolidated limit for medical record requests, improve auditor performance through financial incentives, and improve transparency.

“We don’t oppose audits – they provide needed checks and balances to achieve quality healthcare through quality information,” Gordon says. “However, the existing RAC program is broken and needs immediate changes.”



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