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Monday, January 26, 2015

TMA ASKS CONGRESS TO REFORM RAC AUDITS


On behalf of the Physicians Advocacy Institute (PAI), I wrote several Texas leaders in Congress, asking them to support the PAI plan to relieve the bureaucratic burden on physicians caused by the Recovery Audit Program audits. Our proposal: 
  • Create new clinical and educational standards to ensure recovery audit contractors (RACs) have necessary expertise in determining medical necessity and coding issues;
  • Mandate that RACs provide timely and detailed notification to physicians and providers;
  • Delay contingency payments for RACs until the third level of appeal is exhausted;
  • Require RACs to educate and provide notice on common coding and billing errors; 
  •  Provide physicians with a meaningful opportunity to decide whether to file an appeal; Reduce the look-back period for RAC audits to two years; and
  • Add specific extrapolation standards to the statistical sampling pilot. 

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