Further thoughts on RACs.
Phileo7 .
Description
Collection
Title:
Further thoughts on RACs.
Creator:
Phileo7 .
Date:
8/5/2015
Text:
Tom, thank you for your insight, great thoughts to ponder. May I throw into the ring the following bill which was introduced on May 22, and as of yet I've seen no news about. It's called the Fair Medical Audits Act of 2015. If it passes it just might, as you put it, render some of the points you brought up obsolete. But as of yet, it's just a proposal that needs to gain traction. Of course it's not a total solution, but finally a start... I'll take a first step any day! Perhaps bringing your points to light as you contact your representative could help persuade him/her to cosponsor this bill and get it moving to a vote. I'd say THAT would be an effective and appropriate counter campaign in itself!
You can see current status, representatives currently cosponsoring the bill at the following link... <URL Redacted>
Here are a few of the most interesting items:
H.R.2568“(D) LIABILITY FOR EXCESSIVE OVERTURNED DETERMINATIONS.—Contractors that have a certain percentage (as determined by the Secretary in regulations) of overpayment determinations overturned by an Administrative Law Judge at the Office of Medicare Hearings and Appeals shall be subject to administrative penalty established by the Secretary in such regulations.
“(E) PROVIDER COMPENSATION FOR CERTAIN CONTRACTOR ERRORS.—A contractor shall be liable for payment to providers of service and suppliers for reasonable attorneys’ fees when the contractor’s overpayment determination is equal to or more than double the final overpayment amount determined by an Administrative Law Judge at the Office of Medicare Hearings and Appeals.
and under the section Recoupments...
(1) by striking “until the date the decision on the reconsideration has been rendered.” and inserting the following: “until the date a decision has been rendered at the third level of appeal by an Administrative Law Judge at the Office of Medicare Hearings and Appeals.”; and(2) by adding at the end the following: “Any recoupments made under this subparagraph based on a decision that is subsequently reversed on appeal shall be returned to the provider of services or supplier involved not later than 30 business days after the date of the decision of reversal on appeal.” .
Of course, HR2568 isn't the only Bill out there we should be aware of. A quick search and skimming of www.congress.gov revealed the following bills as well.
HR2156 sponsored by the American Hospital Association, incorporating numerous RAC revisions.
HR1526 includes require that any records or documentation of an orthotist or prosthetist who furnished an orthotic, prosthetic, or prosthetic device to an individual shall be considered part of the individual's medical record in determining whether the item is reasonable and necessary. and Recoupment of payments to a qualifying provider or supplier may not be made before completion of an administrative law judge appeals process.
HR1530 includes Documentation created by an orthotist or prosthetist is considered part of the patient's medical record and Requirements for suppliers of orthotics and prosthetics are separated from those for suppliers of durable medical equipment.
I'm not an expert on the process, but am choosing to become informed. I do understand each of these Bills have a long way to go. While you are signing the petition to rescind medicare's LCD ( <URL Redacted>, perhaps you could also be asking your representative to cosponsor one or all of these Bills.
Good luck everyone, and don't stop making a difference!Kasey Johnson, LP, CP, CPOA
You can see current status, representatives currently cosponsoring the bill at the following link... <URL Redacted>
Here are a few of the most interesting items:
H.R.2568“(D) LIABILITY FOR EXCESSIVE OVERTURNED DETERMINATIONS.—Contractors that have a certain percentage (as determined by the Secretary in regulations) of overpayment determinations overturned by an Administrative Law Judge at the Office of Medicare Hearings and Appeals shall be subject to administrative penalty established by the Secretary in such regulations.
“(E) PROVIDER COMPENSATION FOR CERTAIN CONTRACTOR ERRORS.—A contractor shall be liable for payment to providers of service and suppliers for reasonable attorneys’ fees when the contractor’s overpayment determination is equal to or more than double the final overpayment amount determined by an Administrative Law Judge at the Office of Medicare Hearings and Appeals.
and under the section Recoupments...
(1) by striking “until the date the decision on the reconsideration has been rendered.” and inserting the following: “until the date a decision has been rendered at the third level of appeal by an Administrative Law Judge at the Office of Medicare Hearings and Appeals.”; and(2) by adding at the end the following: “Any recoupments made under this subparagraph based on a decision that is subsequently reversed on appeal shall be returned to the provider of services or supplier involved not later than 30 business days after the date of the decision of reversal on appeal.” .
Of course, HR2568 isn't the only Bill out there we should be aware of. A quick search and skimming of www.congress.gov revealed the following bills as well.
HR2156 sponsored by the American Hospital Association, incorporating numerous RAC revisions.
HR1526 includes require that any records or documentation of an orthotist or prosthetist who furnished an orthotic, prosthetic, or prosthetic device to an individual shall be considered part of the individual's medical record in determining whether the item is reasonable and necessary. and Recoupment of payments to a qualifying provider or supplier may not be made before completion of an administrative law judge appeals process.
HR1530 includes Documentation created by an orthotist or prosthetist is considered part of the patient's medical record and Requirements for suppliers of orthotics and prosthetics are separated from those for suppliers of durable medical equipment.
I'm not an expert on the process, but am choosing to become informed. I do understand each of these Bills have a long way to go. While you are signing the petition to rescind medicare's LCD ( <URL Redacted>, perhaps you could also be asking your representative to cosponsor one or all of these Bills.
Good luck everyone, and don't stop making a difference!Kasey Johnson, LP, CP, CPOA
Citation
Phileo7 ., “Further thoughts on RACs.,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 5, 2024, https://library.drfop.org/items/show/237574.
