Home Health & Hospice Week

A new study shows why Medicare should delay recoupment of RAC-denied claims until after the ALJ hearing.

A study by Dobson DaVanzo & Associates, commissioned by the American Orthotic and Prosthetic Association, shows that the program is paying out a big chunk of its recovered payments in interest to those providers whose appeals succeed at the Administrative Law Judge level.

Putting off payment recoupment from providers until after the ALJ determination “would eliminate the need for CMS to make interest payments, estimated to be … $12.37 million for all of Part B services in the appeal system,” AOPA notes in a release.

“A major side-benefit of such a step would be to relieve the often unbearable financial strain on small health care providers ... that are unable to deal with being bombarded by the uncertainty resulting from long-delayed Recovery Audit Contractor (RAC) appeals for disputed Medicare payments,” the trade group says. “More than 100 small health care businesses already have been forced to close their doors by the pressure from the appeals backlog and many more are in danger of being shuttered.”