Friday, February 14, 2014
WASHINGTON (Feb. 14, 2014)—Today's issue of The Hill, a Washington, D.C., newspaper widely read by politicians, features an Op Ed by Rep. Renee Ellmers (R-N.C.). The congresswoman pulls no punches as she describes the serious ways that CMS has mismanaged the Medicare bidding program. "...CMS believes the system is working. I am here to say it is not," wrote Ellmers. She explains that, "...in September 2012, I held a hearing before the House Small Business Committee to find out whether the program should be expanded from 9 to 91 metropolitan areas. According to our witness testimony, the answer was a resounding 'no.' At the hearing, we learned that the program is fundamentally flawed and violates basic auction principles." Interestingly, Laurence Wilson, director of the Chronic Care Group at CMS and the person who runs the Medicare bidding program, testified that the bidding program "is not an auction." Ellmers agrees with Wilson and writes, "However, without an auction, this program would violate current law." AAHomecare has been working with Rep. Ellmers and many others in both the House and Senate to gain support for fixing the bidding program. Also this week, 111 members of Congress sent a strongly worded letter to Department of Health & Human Services Secretary Kathleen Sebelius expressing their concerns about the recovery audit contractor (RAC) program. While the focus of the letter was "beneficiaries and providers of Medicare inpatient services, hospitals and health systems," HME providers are similarly affected and any fixes to the program should help reduce their burden as well. According to the letter, because of the program's payment structure, "RAC's are incentivized to deny claims, even when the claims are correct." And the Office of Medicare Hearings and Appeals' recent announcement to suspend assigning provider appeals to administrative law judges is further evidence of "the need for reform of the RAC program." The representatives "strongly recommend" CMS: • dedicate additional resources to resolve the OMHA backlog • immediately reform the RAC process to ensure that auditors identify real claim coding and documentation errors • devise an alternative payment structure For more information, visit aahomecare.org.