Illinois Hospital Association

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November 26, 2007

Urge Your U.S. Rep. to Cosponsor HR 4105

DELAY IMPLEMENTATION OF RAC PROGRAM

Action:
Please contact your U.S. Representative immediately and urge him/her to co-sponsor H.R. 4105, IHA backed legislation that will place a one-year moratorium on the Centers for Medicare & Medicaid Services’ (CMS) Medicare Recovery Audit Contractor (RAC) Program. Click here to send an e-mail to your Representative.

Introduced by Reps. Lois Capps (D-CA) and Devin Nunes (R-CA), H.R. 4105 would:

  • Place a one-year moratorium on the CMS’ Medicare RAC program.
  • Direct CMS to provide Congress with a detailed program status report.
  • Charge the Government Accountability Office (GAO) with investigating the accuracy and efficiency of RACs and finding out if they are in compliance with Medicare policy regarding denials and appeals.

Background:
The Medicare Recovery Audit Contractor (RAC) Program was authorized by Congress to identify improper Medicare payments, including both overpayments and underpayments. Paid on a contingency basis, RACs receive a percentage of the improper payments they identify and collect. CMS currently operates the RAC program in five states, California, Florida, Massachusetts, New York and South Carolina, and plans to expand the program nationwide by 2010. Illinois presently is scheduled for 2009 enrollment.

Despite CMS’ recent release of a revised "statement of work" that delays implementation for some hospitals in some states, the agency is scheduled to begin program expansion in March 2008 – before correcting several critical problems identified during the demonstration project.

Delaying implementation of the program, as called for by H.R. 4105, would give CMS time to address key problems with RACs by developing more appropriate payment incentives, providing greater oversight, and increasing transparency of RAC processes.

Urge your U.S. Rep. to cosponsor H.R. 4105 and delay CMS implementation of the Recovery Audit Contractor Program