The survey, covering more than 1,900 hospitals in the first quarter of 2011, found that 84 percent of participating hospitals with complex denials cited medical necessity as a reason for denial.
Here are some other RACTrac survey findings.
• Syncope & Collapse was the top MS-DRG denied by RACs for both medical necessity denials and incorrect coding denials.
• About half of hospitals reported problems with reconciling RAC recoupments and untimely RAC correspondence.
• Nearly one in four hospitals reported problems with RAC rescission of medical record requests and late demand letters.
• Average wait times for a RAC response varied widely, with 18 percent reporting it took 14 days or more to receive a response from their RAC.
• Hospitals reported appealing nearly one in four RAC denials, resulting in a 71 percent success rate.
• More than half said they have not received any education on avoiding payment errors from CMS or its contractors.
• Three-quarters of hospitals reported RACs impacted their organization this quarter and one-half reported increased administrative costs.
• More than half of hospitals with RAC activity reported receiving at least one underpayment determination.
• Most indicated RAC responsiveness and overall communication was “fair” or “good.”
Read the AHA RACTrac report on RACs (pdf).
Related Articles on AHA RACTrack survey results:
10 Findings From the Latest AHA RACTrack Survey
Hospitals Asked to Complete RACTrac survey
Hospitals in RAC Region B Most Successful in Appealing Denials
