Here are 10 key findings on Recovery Audit Contractors' activities from the AHA's RACTrac survey, now receiving input from 1,400 participating hospitals.
1. All four RACs denied $19.2 million in Medicare claims in the first half of 2010.
2. Of reporting hospitals, 972 reported RAC activity and 51 percent reported increased administrative costs due to the RAC program.
3. Nearly $11 million of the denials in the first half of the year were by Connolly Consulting, the RAC for Region C, which covers the South.
4. Complex denials accounted for 85 percent of denied payments and totaled more than $15.5 million.
5. Of hospitals reporting automated denials, 87 percent experienced denials for
outpatient coding and billing errors.
6. Of hospitals reporting complex denials, 91 percent experienced denials for inpatient
coding errors.
7. Complex reviews of medical records for the period involved more than $432 million in total Medicare payments, $214 million of which were for Region C.
8. Participation in RACTrac more than doubled since the first quarter of 2010,
with 1,389 hospitals involved.
9. RAC Region C had the highest number of hospitals reporting RAC activity, but RAC Region D had a higher percentage of participating hospitals reporting RAC activity.
10. Outpatient coding and billing were often the target for automated reviews,
while inpatient coding was a common target for complex review.
Read results of the RACTrac survey.
Read more coverage on RACs.
-CMS to Expand RAC-Style Audits, Double Projected Recoveries
-OIG: RAC Program Lacks Sufficient Fraud Training
-10 Best Practices for Hospitals to Prepare for, Respond to Recovery Audit Contractors
1. All four RACs denied $19.2 million in Medicare claims in the first half of 2010.
2. Of reporting hospitals, 972 reported RAC activity and 51 percent reported increased administrative costs due to the RAC program.
3. Nearly $11 million of the denials in the first half of the year were by Connolly Consulting, the RAC for Region C, which covers the South.
4. Complex denials accounted for 85 percent of denied payments and totaled more than $15.5 million.
5. Of hospitals reporting automated denials, 87 percent experienced denials for
outpatient coding and billing errors.
6. Of hospitals reporting complex denials, 91 percent experienced denials for inpatient
coding errors.
7. Complex reviews of medical records for the period involved more than $432 million in total Medicare payments, $214 million of which were for Region C.
8. Participation in RACTrac more than doubled since the first quarter of 2010,
with 1,389 hospitals involved.
9. RAC Region C had the highest number of hospitals reporting RAC activity, but RAC Region D had a higher percentage of participating hospitals reporting RAC activity.
10. Outpatient coding and billing were often the target for automated reviews,
while inpatient coding was a common target for complex review.
Read results of the RACTrac survey.
Read more coverage on RACs.
-CMS to Expand RAC-Style Audits, Double Projected Recoveries
-OIG: RAC Program Lacks Sufficient Fraud Training
-10 Best Practices for Hospitals to Prepare for, Respond to Recovery Audit Contractors