Department of Rehabilitation Medicine, School of Medicine and Biomedical Sciences, University at Buffalo, NY, USA.
Am J Phys Med Rehabil. 2011 May;90(5):426-31. doi: 10.1097/PHM.0b013e318214ec54.
A perfect storm had been brewing in the last decade: Medicare payment mistakes; Medicare waste, fraud, and abuse; fuzzy medical necessity definitions; erroneous coding; and a strained national budget. The United States Congress responded by inserting Section 306 into the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. Section 306 called for the correction of Medicare payment problems by establishing the Recovery Audit Contractor program as the vehicle for the Centers for Medicare & Medicaid Services to recoup Medicare overpayments as far back as 3 yrs from its healthcare providers and to return underpayments to them. The legislation allowed for Medicare to contract with private firms to follow the money and earn a cut. Caught in the eye of the storm, Medicare providers combined are giving back more than they get back. Inpatient Rehabilitation Facilities are taking back takebacks-but enough to remain viable?
过去十年中，一场完美风暴正在酝酿之中：医疗保险支付错误；医疗保险浪费、欺诈和滥用；医疗必要性定义模糊；错误编码；以及紧张的国家预算。美国国会对此作出回应，在 2003 年的《医疗保险处方药、改善和现代化法案》中插入第 306 条。第 306 条要求通过建立医疗保险恢复审计承包商计划来纠正医疗保险支付问题，该计划是医疗保险和医疗补助服务中心（Centers for Medicare & Medicaid Services）收回医疗保险多付款项的工具，追溯期最长可达 3 年，并将少付款项退还给提供者。该立法允许医疗保险与私营公司签订合同，跟踪资金并从中获利。在这场风暴的中心，医疗保险提供者加起来退还的款项多于收到的退款。住院康复机构正在收回退款——但足以维持生存吗？
