CMS’ figures, which include all providers, differ from the numbers in the American Hospital Association’s most recent RACTrac Survey. According to the RACTrac Survey, hospitals appealed 33 percent of all overpayment claims from RACs, and 75 percent have been ruled in their favor.
However, CMS did not include RAC appeals that are still going through the appeals process: “The number of claims that have been appealed is limited to claims originating in FY 2011, with appeals initiated through 9/30/2011. Each level of the appeal process has statutory timeframes that provide due process to providers. Since these timeframes extend beyond the end of the fiscal year, each update will represent a snapshot in time to ensure accurate data.”
According to the RACTrac, hospitals reported roughly three-quarters of all appealed claims are still sitting in the appeals process.
In total, CMS said providers received $37.9 million in overturned appeals claims from Medicare RACs. Complex review denials constituted the largest portion of that sum at almost $30 million.
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