Hospitals reported appealing nearly one-third of all recovery audit (RAC) denials, and 77 percent of those denied claims were overturned in favor of the hospital, according to the American Hospital Association's third quarter RACTrac Survey (pdf).
AHA conducts the RACTrac Survey quarterly to monitor RAC development, and more than 2,100 hospitals have participated since data collection began in Jan. 2010.
Other key findings from the third quarter RAC survey include the following:
• About 66 percent of medical records reviewed by RACs did not contain an improper payment.
• Since the first quarter of 2010, hospitals have reported $355 million in denied claims.
• Roughly 96 percent of participating hospitals with complex denials cited "medically unnecessary" as a reason for denial. Most of those medical necessity denials were for one-day stays where the care was provided in the wrong setting.
• Eighty-one percent of hospital respondents reported appealing at least one RAC denial.
• Similar to the second quarter results, 71 percent of hospitals reported that RACs impacted this organization in the past quarter, and 51 percent reported increased administrative costs.
• A majority of hospital respondents indicated their RAC's responsiveness and communication was "fair" or "good," but the average wait time for a RAC response varied. Fifteen percent of hospitals said it took two weeks or more to receive a RAC response.
AHA conducts the RACTrac Survey quarterly to monitor RAC development, and more than 2,100 hospitals have participated since data collection began in Jan. 2010.
Other key findings from the third quarter RAC survey include the following:
• About 66 percent of medical records reviewed by RACs did not contain an improper payment.
• Since the first quarter of 2010, hospitals have reported $355 million in denied claims.
• Roughly 96 percent of participating hospitals with complex denials cited "medically unnecessary" as a reason for denial. Most of those medical necessity denials were for one-day stays where the care was provided in the wrong setting.
• Eighty-one percent of hospital respondents reported appealing at least one RAC denial.
• Similar to the second quarter results, 71 percent of hospitals reported that RACs impacted this organization in the past quarter, and 51 percent reported increased administrative costs.
• A majority of hospital respondents indicated their RAC's responsiveness and communication was "fair" or "good," but the average wait time for a RAC response varied. Fifteen percent of hospitals said it took two weeks or more to receive a RAC response.
Related Articles on RACs:
How to Cope in This Economic Climate: 4 Thoughts From Elkhart General CFO Kevin Higdon
Are RACs Performing Enough Provider Outreach?
AHA: 93% of RAC Complex Denials Involve Medical Necessity