Providers aren’t ‘gaming the system’ by pursuing RAC appeals
Regarding the recent article “Hospitals rake in $1.3 billion from Medicare appeals settlements” (ModernHealthcare.com, June 12), I take issue with the statement from one of the sources saying that providers “game the system by appealing every claim denial, bring the appeals system to a standstill and then be paid regardless of the outcome of their case. This essentially incentivizes hospitals to continue to overwhelm the system with frivolous appeals.”
Anyone who has spent time on the receiving end of the recovery audit contractors would never make such an unfounded and uninformed statement. It is not the providers gaming the system—we are taking care of beneficiaries and only trying to get reimbursement for care provided. It is not part of our business plan to place hundreds of thousands of dollars in limbo (remember, the money is taken back) while the backlogged appeals process churns ever slower. Hospitals have spent valuable resources (money and personnel) fighting these take-backs. Nobody would make such an approach the basis for a hospital’s income strategy.
Also, the headline that hospitals are “raking in $1.3 billion” is deceptive. What about the billions providers haven’t recouped and the millions they spend defending themselves?
Michelle McAdoo, RN RAC coordinator/denials management Pardee UNC Health Care Hendersonville, N.C.