Hospital RAC Activity Up More Than 20% From 1Q to 2Q

Hospitals are increasingly seeing more Recovery Auditor (RAC) activity, as medical record requests, number of RAC denials and dollar value of denials increased more than 20 percent in the second quarter of 2012 compared with the first quarter, according to the American Hospital Association's RACTrac Survey (pdf) results from the second quarter of 2012.

Hospitals also reported appealing more than 40 percent of RAC denials with a 75 percent success rate in the appeals process in the second quarter of 2012, figures that are similar to the first quarter.


Here are some other figures from the AHA's second quarter RACTrac Survey:

•    Roughly two-third of medical records reviewed by RACs did not contain an improper payment.

•    Similar to the first quarter, medical necessity denials were the costliest complex denials, according to 84 percent of hospitals.

•    Roughly 67 percent of medical necessity denials were for one-day stays in the wrong setting, not because the care was not medically necessary.

•    Roughly 75 percent of all appealed claims are sitting in the appeals process.

•    Thirty-three percent of hospital respondents said they spent more than $25,000 managing their RAC activity in the second quarter of 2012, and 9 percent spent more than $100,000.

•    Roughly $5.3 billion in Medicare payments were targeted for medical record requests through the second quarter.

More Articles on RACs:

Survey: Non-Profit Hospitals Undergo More Audits Than For-Profits

CMS: 43.4% of Appealed RAC Claims Favored Provider in 2011

75% of Appeal RAC Denials Overturned in 1Q of 2012

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