3 Root Causes of RAC Recoupments 
in Demonstration Period

MedAssets reports that in the demonstration period for the recovery audit contractor program, 93 percent of recoupments fell into three categories:

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1. Fifty percent lacked the proper coding.

2. Thirty-three percent did not meet medical necessity criteria. In many cases, auditors found procedures had taken place in the wrong setting, did not meet admissions criteria or lacked proper documentation.

3. Ten percent failed to meet the 45-day deadline to provide the appropriate documentation.

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