Today, I return to this space after a one-week absence due to my attendance at the AAPC’s National Conference in Las Vegas. Given the venue, I wouldn’t have thought that it would have provided an opportunity to clear my head, but it did provide me a chance to recharge, if not refill my wallet with winnings. In addition, since I attended two breakout sessions that contained incorrect information on the Medicare RAC program, it reinforced the importance of putting good information regarding government audit activities into the public sphere.
Today’s thesis begins with the idea that unintended bad consequences often stem from good intentions. As an example, a few years ago, my family adopted a shelter cat. The unintended consequence of this act of altruism is that he waits until 2 AM to begin his incredibly loud vocal practice, which necessitates that I sleep in close proximity to books, shoes and other projectiles.
Yet there are examples where unintended consequences stem from acts of fury and aggression. As I normally do in this space, I’ll give you a relevant example from the world of American Health Care.
It has now been two weeks since the conclusion of oral arguments at the Supreme Court regarding the Patient Protection and Affordable Care Act. Given the constant drone of virulent opinion towards PPACA coming from the neo-conservative side of the political spectrum, and given that my take on the Supreme Court arguments was that these leaned strongly towards throwing out the entire statute, people in many areas of health care are left wondering about the consequences of a world without the law in place.
As it applies to government audits, suddenly the Medicaid RAC program finds itself with an uncertain future. The program was scheduled to begin on January 1 ,2012, but by my count has yet to produce a single documentation request for any provider in any state. As if that was not enough, only 22 of 50 states have finalized a Medicaid RAC contract, with 4 other states pending an announcement of such a selection. This leaves 24 states without a Medicaid RAC. It should c0me as no surprise that there is a conspicuous overlap between the list of states without a contractor and the list of states suing the federal government to overturn PPACA.
As anyone who has read my blatherings in this space knows by now, I am not a fan of the RAC process as it is currently constituted, as the Medicare RACs have yet to demonstrate a wide-ranging competence with regard to their assigned tasks. I think I can speak for the provider community when I state categorically that no one is looking forward to the expansion of the blind skeet-shooting that has come to symbolize the work of the four Medicare recovery auditors into Medicaid reimbursement.
However, if the Supreme Court acts as I think they will by invalidating PPACA in its entirety, the 5 conservative justices on the Court and the political forces who support them will actually be arguing for improper Medicaid payments to continue unabated. Given the caterwauling about stretched state budgets emanating due to Medicaid from those same governors of states lending their names to the lawsuits that brought PPACA to the steps of the Supreme Court, my logical brain finds itself perplexed by this consequence.
The premature end of the Medicaid RAC program is but one unintended consequence of PPACA’s possible / probable disposal. Given that the final law clocked in at 906 pages in PDF format, many initiatives and programs suddenly find themselves needlessly threatened based on the whims of 5 people in a columned building in Washington, D.C. The setting is somewhat fitting, given the antiquated form of Olympus-like justice that is about t0 befall the act. Given the sheer volume of consequences, I may not need a bellowing cat to keep me up at night for much longer.