Medicare RAC Activity in Q1 2014: 10 Statistics

The American Hospital Association has released the results of its quarterly RacTrac survey for the first quarter of 2014.

The survey measures Medicare recovery auditor, or RAC, activity. AHA created the web-based survey because of the lack of data from CMS concerning the impact RACs have on providers, according to the RACTrac website.

Here are 10 key statistics from the most recent survey, based on responses from 1,165 hospitals.

1. Of the medical records reviewed by RACs during the first quarter, the hospitals surveyed reported 57 percent didn't contain an overpayment, according to the RAC.

2. Nearly 60 percent of hospitals reported experiencing short-stay medical necessity denials.

3. Additionally, 59 percent of hospitals received denials for inpatient coding.

4. Sixty-six percent of short-stay denials for medical necessity were because the care was provided in the wrong setting.

5. Hospitals reported appealing 50 percent of their RAC denials.

6. Hospitals reported a 66 percent success rate in the appeals process.

7. Fifty-five percent of hospitals filing a RAC appeal during the first quarter appealed short-stay medically unnecessary denials.

8. Of the participating hospitals' appealed claims, 63 percent are still in the appeals process.

9. Sixty-nine percent of hospitals spent more than $10,000 managing the RAC process during the first quarter.

10. Additionally, 48 percent of hospitals surveyed reported spending more than $25,000 managing the RAC process.

More Articles on Medicare RACs:
CMS: 5 Key Measures of Success for Medicare RACs  
Rep. Jim McDermott Advocates for More RAC Accountability  
Audit Focus 2014: New Boundaries, Rules Changing the Audit Landscape 


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