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AHIMA Members Advocate for ICD-10, RAC Reform

As part of AHIMA's 12th annual Hill Day, 190 members representing 44 component state associations traveled to Washington, D.C., to urge congressional leaders to continue to move forward with the October 1, 2014, implementation date for ICD-10-CM/PCS and ask for support for the Medicare Audit Improvement Act, which addresses critical operational challenges with the Medicare Recovery Audit Programs.

AHIMA recently cosigned a letter to Marilyn Tavenner, administrator for the Centers for Medicare and Medicaid services (CMS), expressing continued support for the October 1 ICD-10 implementation date. There were 12 cosigners, including the American Hospital Association, the College of Healthcare Information Management Executives, and the Medical Device Manufacturers Association.

“AHIMA was encouraged by Administrator Tavenner’s recent comments that the ICD-10 deadline will go forward, and now we want to assure members of Congress that AHIMA is here to help their constituents prepare for the change,” says AHIMA CEO Lynne Thomas Gordon, MBA, RHIA, CAE, FACHE, FAHIMA. “Continuing to rely on the outdated and imprecise ICD-9-CM platform adversely affects the value of health care data. The time is now to move forward with ICD-10, a more robust coding system that will help reap the benefits of electronic health records and maximize health information exchange. This will lead to better care for patients, a goal AHIMA, other health care stakeholders, and our government leaders all share.”

In addition to discussing ICD-10, members also talked with legislators about the need for the Medicare Audit Improvement Act of 2013 to reform the Recovery Audit Contractor (RAC) program. Although the RAC program was created to identify and recover improper Medicare payments, which AHIMA agrees is important, the RAC program as constructed is broken, lacks transparency, and is overly burdensome and ineffective. According to the American Hospital Association, 75% of appealed RAC denials are overturned in favor of hospitals and providers.

The Medicare Audit Improvement Act of 2013, which was introduced to Congress one year ago, addresses these concerns. The legislation, cosponsored by Representatives Sam Graves (MO-R-6th) and Adam Schiff (CA-D-29th), has 200 cosponsors in the House and 10 in the Senate.

RAC is a particularly timely issue since on February 18 CMS announced a pause of audits in preparation for the procurement of new contracts and to “to continue to refine and improve the Medicare Recovery Audit Program.”

The Medicare Audit Improvement Act has a number of significant benefits including:

• establishing a consolidated limit for medical record requests;

• improving auditor performance by implementing financial penalties and requiring medical necessity audits to focus on widespread payment errors;

• improving recovery audit transparency;

• allowing denied inpatient claims to be billed as outpatient claims when appropriate; and

• requiring physician review for Medicare denials.

“AHIMA and its members are grateful for the opportunity to share our expertise with congressional leaders and clarify any questions they have about ICD-10, RAC, and other important issues in the health care system,” Thomas Gordon says.

Source: AHIMA