The majority of recovery audit contractors' medical necessity denials for care provided in the wrong setting were for one-day stays, according to AHA's latest RACTrac survey.
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