Corporate Compliance

Medicare Audit Improvement Act reintroduced, AHIMA shows support

Medicare Insider, March 26, 2013

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On March 19, Congressmen Sam Graves (R-Mo.) and Adam Schiff (D-Calif.) reintroduced the Medicare Audit Improvement Act,which aims to improve the performance of Medicare audit programs by implementing financial penalties for certain compliance failures.

The bill would amend the Medicare Modernization Act of 2003 to rectify problems identified since the creation of the Recovery Auditor program as a part of that law. Specifically, the Medicare Audit Improvement Act would reinstate and make statutory a hard cap on Additional Document Requests (ADR) on the part of Medicare auditors to 2% of hospital claims with a maximum of 500 ADRs per 45 days, according to a press release from Graves’ office.

The same day that the bill was reintroduced to Congress, the American Health Information Management Association (AHIMA) issued public support for the proposed legislation, saying that it will address critical operational problems that exist with the current Recovery Auditor program and that it will ensure that Medicare Recovery Auditing is efficient, transparent, and fair.

“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,” said AHIMA CEO Lynne Thomas Gordon, MBA, RHIA, CAE, FACHE, FAHIMA in the March 19 press release. “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.”

View the press release from the office of Congressman Graves.

View the press release from AHIMA.

View a previously released article from HCPro on the proposed legislation.

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