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An Attempt to Make Audits Less Burdensome for Hospitals

Posted in Administration, Hospitals, Medicaid

“House members look to ease Medicare audit burden on hospitals” is the title of a recent post by Pete Kasperowicz in his The Hill’s Floor Action Blog.  Last week, four House of Representatives members introduced bill H.R. 6575, that endeavors to ease the burden of a hospital during an investigation by a Medicare contractor, such as a Recovery Audit Contractor (RAC).  Recognizing the multitude of resources needed to respond to an investigation, the bill proposes to limit the documentation requests from such auditors.  The bill also promotes transparency for audit contractors and introduces penalties for contractors that continuously fail to meet recovery requirements, such as audit deadlines and timely communication with hospitals upon denial of a claim.

The introduction of this bill closely follows the Office of Inspector General’s (OIG’s) release of its 2013 Work Plan, in which the OIG announced 112 new investigations for the coming year.  Since some auditors use the OIG Work Plan as a guideline for determining the focus of audits, a review of the 2013 Work Plan may be helpful as hospitals prepare for the possibility of audits in the coming year.  Some of the audit-type items targeted at hospitals include a review of Medicare claims pertaining to same-day admissions, Medicare payments made for patient discharges, payments for cancelled surgeries, and a review of provider-based status for hospital-based entities.  So, even though the 2013 Work Plan might be seen as expanding the potential for an audit or investigation, H.R. 6575 would place a limit on the number of claims a hospital must produce for the government and increase the transparency of auditors’ operations.  This would be a small but welcome change in the compliance environment.