The report broke down the rates for three regional RACs. For Connolly 7.0 percent of determinations were appealed and 66.9 percent of those cases were overturned. For HDI, 14.5 percent of determinations were appealed and 72.9 percent were overturned. For PRG, 8.8 percent of determinations were appealed and 49.8 percent were overturned.
The AHA said it was disappointed with the report because it did not break out data on appeals of complex audits. Complex audits, based on an auditor’s subjective finding, tend to have a greater dollar impact on hospitals have much rates of appeals and are more likely to overturn RAC decisions.
Read the CMS report on recovery audit contractors.
Read the AHA response to the RAC report.
At Becker's 4th Annual CEO + CFO Roundtable, taking place November 2–5 in Chicago, more than 1,500 hospital and health system executives tackle decisions that determine whether organizations thrive or merely survive: protecting margins under cost pressure, choosing where to grow, renegotiating payer relationships, stabilizing the workforce and proving real ROI on technology. This is where leaders work through them together, face-to-face. Apply for complimentary registration now.
