The American Orthotic & Prosthetic Association is proposing a change to Medicare's recovery audit contractor program that it contends would keep providers from suffering devastating financial losses while appealing disputed claims.
Providers should not have to refund alleged overpayments identified by RACs until after an administrative law judge reaches a decision on an appeal, the group said. Now, even providers that are in the right end up short on cash, in some cases for years, because of the backlog of RAC appeals, association leaders said.
RACs examine providers' claims to ensure the Medicare payments they received were accurate and appropriate. The CMS outsources the program to four private companies and pays them a contingency fee for every overpayment they find.
“More than 100 orthotic and prosthetic providers already have shut down due to delays in the Medicare appeals process and hundreds more are at risk of suffering the same thing,” said Charles Dankmeyer, the association's president. “There's no end in sight to this monster backlog.”
The move, Dankmeyer said, would also save Medicare money. Now, if the administrative law judge rules in a provider's favor, the CMS must return the payment with interest. In 2013, the CMS owed orthotic and prosthetic providers who won appeals before the judge an estimated $85,661 in interest.