When CMS released the results of the Recovery Audit Contractor program one month ago, there were no details about the quality of the work being performed by the RAC contractors. With this gap in data, I continue to revisit the American Hospital Association’s RACTrac report, which is an ongoing voluntary hospital survey that gauges RAC activity and its effect on facilities providing information. The latest results, for activity through the 1st Quarter of 2011, was released this past Friday, May 20th. It paints a picture of a gang of would-be bandits still out on the range, aiming their weapons at whiskey bottles, and learning how to shoot straight.
Among the more salient findings from responding hospitals were:
These and other responses to the survey point to nascent RAC processes that are succeeding only in forcing hospitals to shuffle mountains of paper for ultimately no purpose. Lurking in the background is CMS, who appears not to be focused on bringing information on the RAC program to the health care community.
Beyond the failings of the program on many levels are illustrations of where the RACs appear to be concentrating their efforts. It appears that one-day stays related to syncope and collapse have become a popular target for medical necessity denials. Further, these types of denials are occurring more often because the services were found to have been billed with the incorrect place of service, rather than the services not being medically necessary.
One point of good news is that participating hospitals reported $17.4 million in identified underpayments, which by force of coincidence may be paying the administrative costs of responding to complex RAC requests that end up going nowhere upon investigation.
While the AHA RACTrac survey offers only a partial picture of the performance of the RAC contractors, I continue to await the comprehensive picture of appeals and quality that only CMS can provide. For a process that is touted as an important funding lynchpin for the implementation of the Affordable Care Act, it is becoming obvious that this vision is threatened by the RACs and their collective learning curves.
Learn more about Fi-Med Management.
Related Articles on RACs:
A Primer on Audits by RACs MACs, ZPICs and CERTs
RACs Focusing on One-Day Stays, RACTrac Survey Reports
CMS Newsletter Addresses How to Avoid Errors Picked up by RACs
Among the more salient findings from responding hospitals were:
- 74% of all complex reviews requiring review of medical records did not result in an improper payment determination;
- 21% of all RAC denials were appealed nationwide, with 71% of those that have completed the appeals process being overturned in favor of the provider. This second number may actually be higher, as 60% of all appeals are still in process;
- 49% of responding hospitals report that administrative costs have increased as a result of RAC activity; and
- 55% of the respondents to the survey indicated that they have yet to receive, either from CMS or its contractors, any education related to avoiding payment errors.
These and other responses to the survey point to nascent RAC processes that are succeeding only in forcing hospitals to shuffle mountains of paper for ultimately no purpose. Lurking in the background is CMS, who appears not to be focused on bringing information on the RAC program to the health care community.
Beyond the failings of the program on many levels are illustrations of where the RACs appear to be concentrating their efforts. It appears that one-day stays related to syncope and collapse have become a popular target for medical necessity denials. Further, these types of denials are occurring more often because the services were found to have been billed with the incorrect place of service, rather than the services not being medically necessary.
One point of good news is that participating hospitals reported $17.4 million in identified underpayments, which by force of coincidence may be paying the administrative costs of responding to complex RAC requests that end up going nowhere upon investigation.
While the AHA RACTrac survey offers only a partial picture of the performance of the RAC contractors, I continue to await the comprehensive picture of appeals and quality that only CMS can provide. For a process that is touted as an important funding lynchpin for the implementation of the Affordable Care Act, it is becoming obvious that this vision is threatened by the RACs and their collective learning curves.
Learn more about Fi-Med Management.
Related Articles on RACs:
A Primer on Audits by RACs MACs, ZPICs and CERTs
RACs Focusing on One-Day Stays, RACTrac Survey Reports
CMS Newsletter Addresses How to Avoid Errors Picked up by RACs