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The Government Accountability Office (GAO) has released a report that found the many varying requirements of the four types of contractors Medicare uses to conduct post-payment reviews imposes an administrative burden on providers. GAO reviewed the different requirements for post-payment review for Medicare Administrative Contractors (MACs), Zone Program Integrity Contractors (ZPICs), Recovery Audit Contractors (RACs) and Comprehensive Error Rate Testing (CERTs) to assess how the differences between the programs impede efficiency and effectiveness. GAO also found that RACs, who are paid fees contingent on the amount of claims recouped or adjusted, conducted almost five times as many reviews as the other three contractors combined, whose reimbursement is not dependent on the amount of their claims reviews. The GAO recommended that the Centers for Medicare & Medicaid Services review the differences between programs to determine those that can be made more consistent and take actions to reduce those differences within an established and publicized timeline. The report is available at www.gao.gov/products/GAO-13-522.
The report’s findings echo the concerns California’s hospitals have expressed about the administrative burden associated with the RAC program. CHA continues to advocate for H.R. 1250, the Medicare Audit Improvement Act, and urges members to contact their representatives to co-sponsor the bill. More information is available at www.calhospital.org/advocacy-alert/urge-representatives-support-changes-rac-program-delay-cuts-medicare.
