Beware the RAC…

by Dr. S. Russell Vester, MD 14. March 2014 08:10

Dr. S. Russell Vester

Ever heard of the RAC? Well I hadn’t either until about a year ago. It turns out that RAC is yet another government acronym. This one stands for “Recovery Audit Contractor.”

The RAC was conceived as the enforcement arm of Medicare and Medicaid. It was put into law in 2006 and as of 2010 had to be in place in all fifty states. Its original intent was to look for fraud and abuse among those receiving payment for delivering care to Medicare and Medicaid recipients. Fair enough.

Where things have gone awry is with Medicare regulations since then. Someone, in an effort to create an issue where there was a high probability of finding someone breaking the rules, decided that a regulation should be passed mandating that every verbal or telephone order issued by a physician to a nurse must be signed, dated and timed - all three - within 48 hours or the service carried out from that order would be treated by Medicare as if it did not happen. And if it was deemed by the RAC that it did not happen, then Medicare would not have to pay for it and would demand a refund for payment for that service!

Now think about this. If you are a physician on call over a weekend and you cover for other physicians that may have patients in multiple hospitals, you will be giving phone orders to nurses in hospitals all weekend long. Dozens and dozens of them. In one hospital this past weekend alone I personally gave 84 phone orders on one sick patient at one hospital. And I was covering six hospitals in total. Once those orders are given I then have 48 hours to make sure they are signed, dated and timed or I can be found to be breaking one of Medicare’s rules.

Absolutely and completely nuts. It is all but impossible from a practical sense to be compliant with such a regulation no matter how hard you might try.

I doubt there is a physician who regularly sees Medicare patients who is 100% compliant with this regulation. How could anyone be? Don’t think the RAC isn’t aware of this. As regulators, they are counting on this.

From a patient care perspective, this regulation is meaningless. Signing a verbal order is done for the lawyers to prove, were it to come under legal review such as in a malpractice care, that you did indeed issue the order in question. Apart from this exceptional circumstance, signing verbal orders amounts to so much extra busywork.

What the RAC now has is a dependable mechanism to recover revenue from hospitals and doctors that will help fund budget shortfalls. Once again our government has found a way to make others pay for their fiscal mismanagement.

And do you really wonder why right now more heart surgeons are retiring or leaving their field each year than are entering it?

Go figure.

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