RAC re­ver­sal rate mis­leads on au­dit ef­fec­tive­ness

Modern Healthcare - - COMMENT -

Re­gard­ing the re­cent ar­ti­cle “RACs re­couped $3B for Medi­care in 2013” (Mod­ern­Health­care.com, Sept. 29), I am a health­care statis­ti­cian who works very closely with pre- and post-au­dit com­pli­ance risk and mit­i­ga­tion is­sues. I would strongly dis­agree with the va­lid­ity of the 18.1% re­ver­sal rate claimed by the RAC trade group. This num­ber is so low be­cause so few, if any, of the ap­peals made it to the ad­min­is­tra­tive law judge level in a timely man­ner where, his­tor­i­cally, the re­ver­sal rate runs be­tween 72% and 85%, de­pend­ing on which study you read.

This is a clas­sic tale of how to lie with statis­tics and grossly ex­ag­ger­ates the ef­fec­tive­ness of the RACs. Be­cause the RACs have done such a dis­mally poor job, there is a back­log of over half a mil­lion ap­peals wait­ing for ALJ hear­ings and a two-year mora­to­rium on even sched­ul­ing a hear­ing. If you re­ally want to get an ac­cu­rate han­dle on the re­ver­sal rate, wait a cou­ple of years and match the ap­peals back to the find­ings in 2013. I am very dis­ap­pointed to see that num­ber ap­pear like this, be­cause it hurts the ef­forts of providers and their as­so­ci­a­tions to get com­pli­ance re­form in place.

Frank Co­hen Spring Hill, Fla.

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