Hospitals Appeal 12.7% of RAC Decisions, Win 64.2% of Appeals

Tags: CMS | hospital business | Medicare

In Medicare's three-year recovery audit contractor demonstration program, providers appealed 12.7 percent of RAC determinations and won 64.4 percent of those appeals through March 9, 2010, according to a report by CMS.

The report broke down the rates for three regional RACs. For Connolly 7.0 percent of determinations were appealed and 66.9 percent of those cases were overturned. For HDI, 14.5 percent of determinations were appealed and 72.9 percent were overturned. For PRG, 8.8 percent of determinations were appealed and 49.8 percent were overturned.

The AHA said it was disappointed with the report because it did not break out data on appeals of complex audits. Complex audits, based on an auditor's subjective finding, tend to have a greater dollar impact on hospitals have much rates of appeals and are more likely to overturn RAC decisions.

Read the CMS report on recovery audit contractors.

Read the AHA response to the RAC report.

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