Medicare and Medicaid regulations have grown increasingly bulky and burdensome, a hospital trade group recently said, and it’s time for Congress to step in and make things right. I recently wrote about a letter to Congress from the American Hospital Association expressing worry over the expanding number of CMS program integrity contractors and the resulting number of hospital audits. In many cases, the AHA said multiple contractors are investigating the same claim, and hospitals are forced to divert time and resources that could better be used on patient care. 

New regulations from Congress should require CMS to cut back on duplicate audits and streamline the entire contractor program, the AHA said. Congress should also refocus CMS efforts on stopping improper payments, not denying otherwise valid claims for technical reasons. For example, CMS contractors currently deny claims if they’re billed as inpatient when the service was really outpatient, even if the service was legitimate and necessary. Congress could fix this by requiring CMS to let hospitals re-bill claims under the right patient setting, the AHA said.