By Findalis of Monkey in the Middle
That is what is happening in many of the smaller Hospitals in the United States these days. So it is being reported by Dr. Thomas M. Hamilton MD, better known as The Grouch.
We had staff meeting yesterday at the hospital. A topic of discussion was RAC audits and a specific case affecting our hospital.
If you don’t know what RAC audits are, do a Google Search on it and read about it for yourself. I betcha most of you have never heard of such a thing.
Anyway, I felt compelled to write my Congresswoman, Marsha Blackburn, and my two Senators, Bob Corker and Lamar Alexander over this issue. I know I’ll probably get the standard form reply, but it made me feel better anyway. Here it is:
I feel the need to make you aware of the serious situation created for small hospitals under the RAC (Recovery Audit Contractor) program created by Medicare.
I am a physician at our local hospital. During staff meeting yesterday, we discussed a situation concerning a recent surgical case. A patient had a lesion surgically removed. The doctor’s note read as follows, “an eleven blade scalpel was used to remove the lesion”.
The RAC auditor reviewed this chart and stated that the note should have read, “an eleven blade scalpel was used to EXCISE the lesion”.
Because the word REMOVE was used instead of the word EXCISE, the RAC auditor declared that the hospital should refund Medicare an amount of $11,000. The hospital appealed and pointed out to the auditor that there was essentially no difference in the words EXCISE and REMOVE. To no avail, the auditor stated the hospital owed Medicare $11,000.
Senator/Congresswoman, these RAC audits are an exercise in pure lunacy. I hope you can see the obvious stupidity imposed on hospitals by the intrusion of the United States Government by this example above. I would also hope that you would take steps to relieve us of the burden of these nonsensical RAC audits. If you don’t, many hospitals like ours simply will not survive and will end up closing the doors.
It is my understanding that the bureaucrats involved in the RAC audits are entitled to a third of the funds they recover from hospitals. So out of that $11,000 dollars they are squeezing from our hospital over the definition of a single word, the auditors themselves stand to collect $3666.66 for themselves. Senator/Congresswoman, can you truly believe that hospitals will be treated fairly under such a system? If a private entity conducted itself in a manner similar to the RAC auditors, the people in that entity would be jailed.
Of course if Barack Obama has his way we will end up with single payer health care for all which will no doubt be broke like Social Security and Medicare. More and more hospitals will close. So much for universal health care.
Right now our hospital makes about 46 cents for every dollar billed to Medicare. We make 24 cents for every dollar billed to Tenncare (Tennessee Medicaid). I am told under the proposed Medicare cuts and RAC audits we can see our reimbursement fall to 32 cents for every dollar billed to Medicare. You can see we are slowly but surely being strangled by Uncle Sam. Our doctors, nurses, and other hospital staff work hard to provide health care to some very old and very sick people. We deserve honest payment for our efforts rather than a bunch of shenanigans invented by Medicare designed to avoid payment.
Senator/Congresswoman, I implore you to look into this thing called RAC audits. Talk to your constituents in the health care field. They will tell you the same thing I am telling you. We are being strangled by this government nonsense.
I am looking for a personal and thoughtful reply from you on this matter, not the usual form reply provided by a staffer.
Thomas M. Hamilton MD.
Finish reading here.
I find it troubling that the “auditor” receives a “reward” of 1/3 of all monies collected, thus discouraging a true audit of books since it is in the auditor’s best interest to “find” fault in every search.
Thus the word Excise, meaning to cut out or off, as a tumor. And the word Remove, meaning to take away, withdraw, or eliminate is not considered equal in intent. This auditor has taken it upon his/herself to become the standard exemplary of the English Language.
This is only one example of what is happening now and will happen when Obamacare is implemented in its full force.
Is it no wonder that thousands of doctors are planning to leave the profession. Where will the government find their replacements?