Proposed Legislation Could Speed Up Audit Process, Increase Transparency

by Richard Quinn •

Richard Quinn is a freelance medical writer based in New Jersey.

AFIRMing the Details

The Audit and Appeal Fairness, Integrity, and Reforms in Medicare (AFIRM) Act of 2015 would speed up the recovery audit (RA) appeal process—formerly known as the recovery audit contractor (RAC) initiative. Specifics of the proposal include:

  • Adding Medicare magistrates who could handle certain appeals, easing the backlog on judges;
  • Adding a new CMS ombudsman to further speed the process;
  • Increasing the current amount in controversy threshold from $150 in fiscal year 2015 to “be raised to a threshold equal to the amount in controversy as required for Medicare appealed claims to be heard at the federal court level”;
  • Allowing decisions to be rendered without a hearing in cases where no material disputes exist; and
  • Shortening look-back periods to no more than six months after the date of service in cases where claims are submitted within three months of care delivery.

Source: RACmonitor