• Skip to primary navigation
  • Skip to main content
  • 1-800-960-1371
  • Agent Login
  • Quoting Tools
    • Life
    • Senior
  • Free Marketing Guide
  • Blog

AgentLink

With AgentLink, you have easy access to the carriers you want and the tools and resources you need to offer the best to your clients.

  • Products
        • Life
          • Info
          • Products
          • AML Training
          • Quoting Tool
        • Senior
          • Info
          • Products
          • Certifications
          • Compliance
          • Quoting Tool
        • Group Benefits
          • Info
          • Products
          • Our Process
          • Quote Request Form
        • Individual Benefits
          • Info
          • Products
          • Our Process
          • Enrollment Tool
        • See our Concierge Services
  • Tools
  • Resources
    • Marketing Guide
    • Carrier Links
    • Group Compliance Resources
    • Sales Webinars
    • Training Webinars
    • Insurance Marketing Webinars
  • About
  • Contact Us
  •  1-800-960-1371
  • Life Quoting Tool
  • Senior Quoting Tool
  • Marketing Guide
  • Blog
Previous
Next

Medicare’s audit contractors are failing, say lawmakers and hospitals

Providers and members of Congress are pushing the CMS to rethink its tactics for reducing the number of improper Medicare claims. 

“The bottom line is, despite doing more audits than ever before, Medicare just isn’t getting the job done when it comes to preventing payment errors,” Sen. Bill Nelson (D-Fla.), chairman of the Senate Special Committee on Aging said during a roundtable discussion Wednesday. 

Hours before the roundtable, the committee released a bipartisan report (PDF) that found improper Medicare payments have climbed from 8.5% in fiscal year 2012 to 10.1% or $50 billion in FY 2013, despite the fact the CMS has hired more recovery audit contractors to track providers who may be overbilling for Medicare services.

The lawmakers said the RAC program may be failing to change behavior because its incentive structure is based on recovering money that Medicare shouldn’t have paid rather than reducing improper claims. The contractors receive contingency fees of 9%-12.5% for their recoveries.

“This could be viewed as providing an incentive to keep improper payment rates high,” the Senate report says. 

Members of Congress would like to see the CMS explore ways to incorporate the contractors’ effectiveness at reducing improper payment rates over time into financial incentive structures. 

The lawmakers assembled a roundtable of providers, consultants, lawyers, and auditors to find ways to improve the program. The CMS, according to Sen. Susan Collins (R-Maine), declined to participate, which she called “very odd and frankly unacceptable.” 

The American Hospital Association recommended that the CMS impose a financial penalty on RACs when a denial is overturned on appeal, arguing the program needs a check on the strong financial incentive RACs have to deny claims. Melinda Hatton, senior vice president and general counsel of the hospital trade group, pointed to a report from HHS’ Office of the Inspector General finding that its members were successful in 72% of the inpatient claims denials that they appealed. Some hospitals have reported success rates above 95%, Hatton said said.

Another way to counter the draw of the RACs’ contingency fee would be to delay the payments to the contractors until the appeals are exhausted, said Margaret Hambleton, vice president of corporate compliance at San Francisco-based health system Dignity Health.

The CMS is making changes to the RAC program as it prepares to award a new round of contracts. For example, the contractors won’t be paid the contingency fee until their decisions have been upheld at the second level of the six-stage appeals process. The Government Accountability Office approved that change after two contractors protested the terms. The previous RAC contracts expired in February. 

The appeals process, meanwhile, has become so clogged that a handful of hospitals and systems recently joined the AHA in a lawsuit asking a judge to compel HHS to fulfill its statutory obligation to resolve appeals within 90 days. The current average is 16 months. 

Filed Under: Medicare, News and Updates

Previous Post: « How to frame annuities more attractively
Next Post: Telehealth Progresses: Medical Boards Draft Plan to Ease Path to Out-of-State and Online Treatment »

You might also enjoy...

Our companies health is importantWe Prioritize our Health and We Won an Award to Prove it!

Each year the Worksite Wellness Council of Louisville puts on a symposium, a partner of the Mayor’s healthy hometown movement. The 9th annual conference and awards presentation was held on May 18th at the Gheens Foundation Lodge. We got to be a part! At this event, […]

Read More
AgentLink – A brief overview of our Past, Present and Future.

AgentLink (originally called MedLink) was founded in 1991 by Randy McDevitt. Randy is still part of our executive team and serves as Chairman. His son Matt McDevitt is the CEO and Kathy Hamilton is our COO. AgentLink started as a Managing General Agent (MGA) for one […]

Read More

Don’t forget to browse the free tools and resources we offer our agents and prospects, including our popular online quoting tools

Download the Digital Marketing Guide

Go to Resources

Get Contracted Now

Contract with us, to get appointed with your desired carriers

Please enter your email address below  to stay up-to-date with changes in the industry.

  • This field is for validation purposes and should be left unchanged.

Copyright © 2022 · Showcase Pro on Genesis Framework · WordPress · Log in

  • About
  • Contact
  • Careers
  • Life
  • Senior
  • Group Benefits
  • Concierge Services

Agent Login

Resources

Tools

Free Marketing Guide

1-800-960-1371

AgentLink Kentucky Office
2001 Lake Point Way, PO Box 23570
Louisville, KY 40223
Toll Free: 800.960.1371
Direct: 502.245.1371
Fax: 502.245.0978

AgentLink Indiana Office
3077 East 98th Street, Suite 135
Indianapolis, IN 46280
Toll Free: 866.462.9067
Direct: 317.569.8490
Fax: 317.569.8705

Copyright © 2021 AgentLink. All Rights Reserved.
Website Design and Digital Marketing by The Marketing Squad

  • Senior Products
  • Quoting Tool
  • Get Contracted
  • Brittney: 502-245-1371
  • Life Products
  • Quoting Tool
  • Get Contracted
  • Scott: (502) 245-1371
We use cookies to make our website a better place. Cookies help to provide a more personalized experience for you and web analytics for us. To learn more, and to see a full list of cookies we use, check out our Privacy Policy.
Cookie SettingsAccept
Manage consent

Privacy Overview

This website uses cookies to improve your experience while you navigate through the website. Out of these, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. We also use third-party cookies that help us analyze and understand how you use this website. These cookies will be stored in your browser only with your consent. You also have the option to opt-out of these cookies. But opting out of some of these cookies may affect your browsing experience.
Necessary
Always Enabled
Necessary cookies are absolutely essential for the website to function properly. This category only includes cookies that ensures basic functionalities and security features of the website. These cookies do not store any personal information.
Non-necessary
Any cookies that may not be particularly necessary for the website to function and is used specifically to collect user personal data via analytics, ads, other embedded contents are termed as non-necessary cookies. It is mandatory to procure user consent prior to running these cookies on your website.
SAVE & ACCEPT
  • Products
    ▼
    • Life
      ▼
      • Info
      • Products
      • AML Training
      • Quoting Tool
    • Senior
      ▼
      • Info
      • Products
      • Certifications
      • Compliance
      • Quoting Tool
    • Group Benefits
      ▼
      • Info
      • Products
      • Our Process
      • Quote Request Form
    • Individual Benefits
      ▼
      • Info
      • Products
      • Our Process
      • Enrollment Tool
    • See our Concierge Services
  • Tools
  • Resources
    ▼
    • Marketing Guide
    • Carrier Links
    • Group Compliance Resources
    • Sales Webinars
    • Training Webinars
    • Insurance Marketing Webinars
  • About
  • Contact Us
  •  1-800-960-1371
  • Life Quoting Tool
  • Senior Quoting Tool
  • Marketing Guide
  • Blog