I’m not sure if I agree with AHIMA’s advocacy in favor of HR 4105, to impose a moratorium on the use of recovery audit contractors (RAC) under the Medicare Integrity Program. While I understand there have been issues in the demonstration project, the job of audit recovery is to find payment and collection errors. Many of the inpatient coding problems associated with RAC denials are due to problematic coding advice i.e., “Clarifications” and grouper inconsistencies. Should an excisional debridement qualify as an “operating room” procedure? I would probably move it to a “non-OR” status in this day and age. I would think that the government would want to have a RAC look closely at a new (actually not so new) MS-DRG severity system to help find those payment errors. There is a clear winner when you compare the RAC results with previous QIO (or PRO or PSRO) efforts.
Here’s the content of the bill.
If you get a chance when on the THOMAS Library of Congress site, select the GPO’s PDF display (of the bill). Click on “Continue to the GPO” site. Save the file, “getdoc.cgi” to your desktop. This is the actual bill as it appears in print. Change the file name to have a PDF extension (e.g., hr4105.pdf). Now open the PDF file and view a beautiful Congressional document. Here’s a Wikipedia article on the Common Gateway Interface.
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