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Medicare RAC refusal came in wake of already vetted care

LETTER — Posted March 18, 2013

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We have appealed a Medicare Advantage plan audit of a couple of inpatient mental health admissions that were a year ago. These cases underwent concurrent review, and the cases were approved in full during these concurrent reviews. We, in good faith, provided the appropriate care that was authorized and we subsequently received payment for.

A recovery audit contractor then reviewed the cases and, based on their chart review, they were denied. This is totally unacceptable. Apparently, concurrent review means next to nothing. “Managed care” has hit a new low. If providers cannot even count on the managed care organization to provide appropriate authorization for care, then why are we even bothering to waste time on concurrent review?

Michael A. May, MD, Corvallis, Ore.

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