More RAC Activity Focused on Setting, Not Necessity of Care

Recovery audit contractor reviews are on the rise, taking aim at care delivered in the wrong setting, according to the American Hospital Association's latest quarterly RACTrac survey (pdf).

The survey's 1,233 hospitals this quarter responded that they had appealed 41 percent of RACs' Medicare claims denials, with a 72 percent success rate. Most denials were due to medical necessity, though nearly two-thirds of these pertained to care delivered in the wrong setting, not care that was unnecessary.

The American Hospital Association will host a free webinar on RAC policy developments on March 26.

More Articles on Recovery Audit Contractors:

18 Recent Medicare, Medicaid Issues
CMS Issues FY 2011 Medicare RAC Report to Congress
4 Tips to Fight RAC Denials and Win

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