Hospitals reported roughly 93 percent of complex denials from recovery audit contractors involved medically unnecessary claims, according to AHA's second quarter RACTrac Survey.
The survey, which included more than 2,000 hospitals, also showed that the majority of medical necessity denials reported were for one-day stays where the care was provided in the wrong setting, not because the care was not medically necessary. More than two-thirds of medical records reviewed by RACs did not contain an improper payment, as well.
Other key findings from the survey include the following:
• $226 million in denied claims have been reported since the first quarter of 2010.
• Hospitals that participated in the survey appealed almost one in four RAC denials and had an 85 percent success rate in the appeals process.
• Two-thirds of participating hospitals with RAC activity received at least one underpayment ruling.
• Seventy-two percent of surveyed hospitals said RACs impacted their organization this quarter, and 49 percent said there were increased administrative costs.
• Roughly 55 percent of respondents said they have not received any education related to avoiding payment errors from CMS or its RACs.
• While most hospitals reported they are receiving demand letters late, a majority said RAC responsiveness and overall communication was "fair" or "good."
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The survey, which included more than 2,000 hospitals, also showed that the majority of medical necessity denials reported were for one-day stays where the care was provided in the wrong setting, not because the care was not medically necessary. More than two-thirds of medical records reviewed by RACs did not contain an improper payment, as well.
Other key findings from the survey include the following:
• $226 million in denied claims have been reported since the first quarter of 2010.
• Hospitals that participated in the survey appealed almost one in four RAC denials and had an 85 percent success rate in the appeals process.
• Two-thirds of participating hospitals with RAC activity received at least one underpayment ruling.
• Seventy-two percent of surveyed hospitals said RACs impacted their organization this quarter, and 49 percent said there were increased administrative costs.
• Roughly 55 percent of respondents said they have not received any education related to avoiding payment errors from CMS or its RACs.
• While most hospitals reported they are receiving demand letters late, a majority said RAC responsiveness and overall communication was "fair" or "good."
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