NRMC board discusses impact of Medicare overpayment program

The Nevada Regional Medical Center board of directors met Tuesday in the mezzanine conference room. The first order of business was the Recovery Audit Contractor program, its impact on the hospital and possible ways to deal with issues relating to it.

Two representatives from the Health Care Advisory Board were on hand to give the board an educational presentation, Amanda Ivanovics and Zach Stillerman. The two gave a brief overview of the history of the program, which uses contractors for the government to look into overpayments to hospitals from Medicare. The contractors revenue depends on the money recovered from hospitals and have a strong incentive to find as many overpayments as they can.

After the overview, the two looked at some specific data pulled from NRMC records and estimated that the hospital's possible loss could run as high as $1.8 million.

Stillerman told the board that a pilot program, involving five states, had already been completed and said that one of the lessons learned was that hospitals had to be prepared for a blizzard of paperwork.

"They can ask for 60 records every 45 days," Stillerman said. "Even the best-run hospitals found themselves overwhelmed. It wasn't the first wave that did it, it was the second and third requests coming in on top of the first, with multiple deadlines, and the requests just keep coming. Deadlines got missed and missing a deadline is an automatic denial with no appeal."

Dr. William Turner had questions about the confidentiality of records sent to the RACs.

"Are we going to be sending patient information to these RACs?" Turner asked. "I mean you can't even walk down the hall without covering a chart or you're breaking the law. They're going to have this information and its going to have all the patients information with it?

Ivanovics answered that the RACs would have complete information on patients, their diagnosis, and their treatment.

Hospital CEO Judy Feuquay told the board the presentation was intended to be educational and not a sales pitch for the Health Care Advisory Board. Having said that at the end of the meeting Feuquay said she had changed her mind about the program.

"I've been avoiding meeting with them for a month and a half while they worked with Cindy and Holly," Feuquay said. "At first I was against HCAB but I'm not sure it's not a good idea to talk about it at this time"

The board voted to give Feuquay authority to negotiate a three-year contract with HCAB as long as it contained a provision to opt out at the end of the first year if the hospital did not think their services were worth the cost.