AHA: More Than 70% of Hospitals Successfully Appeal RAC Denials

Roughly 74 percent of hospitals between Oct. 1, 2011, and Dec. 31, 2011, were successful in the appeals process of a recovery auditor (RAC) denial, according to the American Hospital Association's fourth quarter RACTrac Survey (pdf).

The results were similar to the third quarter of 2011, when 77 percent of hospitals successfully won their RAC appeal.


The AHA has now conducted its RACTrac Survey for two full years. In every quarter of 2011, the hospital success rate on RAC denial appeals has been higher than 70 percent. Last month, CMS announced the Medicare RAC program has collected $1.27 billion in overpayments since October 2009, with $797.4 million of that amount coming in fiscal year 2011, although those figures do not account for RAC appeals won by providers.

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

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

•    Since the first quarter of 2010, hospitals have reported $444 million in denied claims. That figured jumped $89 million from the third quarter of 2011.

•    Most complex denials continue to be related to short-stay medical necessity, and most medical necessity denials were for one-day stays where the care was provided in the wrong setting, not because the care was not medically necessary.

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

More Articles on RACs:

How to Bill for Renal and Urinary Tract Disorders and Avoid RACs

Medicare RACs Collected $1.27B in Overpayments Since 2009

5 Tips for an Effective RAC Appeals Process

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