Health Information Management

AHA sues HHS over RAC review delays

HIM-HIPAA Insider, June 9, 2014

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by Jaclyn Fitzgerald, Editor

 
The American Hospital Association (AHA) and three hospitals took aim at Recovery Audit Contractors’ (RAC) denials and appeals process by filing a lawsuit against HHS May 22, according to AHA News.
 
AHA filed the lawsuit because it thinks RAC denials are often “excessive and inappropriate.” In addition, AHA is fighting back against the HHS’ December 2013 decision to suspend the assignment of Administrative Law Judges (ALJ) to appeals hearings. This suspension not only contradicts the requirement that the ALJ review an appeal and issue a decision within 90 days, but it has created an appeals backlog. The wait time for an ALJ hearing could exceed three years, which delays Medicare reimbursement for hospitals. Currently, more than 480,000 appeals need to be assigned to an ALJ, according to ACA News.
 
Baxter Regional Medical Center in Mountain Home, Arkansas, Covenant Health in Knoxville, Tennessee, and Rutland (Vermont) Regional Medical Center joined AHA in filing the suit. The three covered entities have more than $8.9 million in combined pending RAC appeals, ACA News reported.



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