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.