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

Hospitals recently reported appealing nearly one-third of all recovery auditor (RAC) denials, and 75 percent were overturned in favor of the hospital, according to the American Hospital Association's RACTrac Survey (pdf) results from the first quarter of 2012.

The recent RACTrac survey, now entering its third year, continued to show the trend that hospitals confident in their appeals process win their cases a majority of the time.


Other figures from the AHA's first quarter RACTrac Survey include:

•    More than 67 percent of medical records reviewed by RACs did not contain an improper payment.

•    The costliest complex denials were medical necessity denials.

•    Seven percent of hospitals spent more than $100,000 managing their RAC process during the first quarter of 2012, while 34 percent spent more than $25,000.

•    Roughly half of all hospital respondents said the biggest problem within the RAC process is that they are not receiving a demand letter.

•    Among participating hospitals, $4.3 billion in Medicare payments were targeted for medical record requests through the first quarter of 2012.

More Articles on RACs:

9th Circuit Appeals Court Weighs Decisions Over Old RAC Reviews

CMS Caps Medical Record Reimbursement for RAC Audits

RAC "Take-Backs" Increase, Expected to Escalate More

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