Health Information Management

AHA releases quarterly RACTrac survey results

HIM-HIPAA Insider, June 23, 2014

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by Jaclyn Fitzgerald, Editor

 
The American Hospital Association’s quarterly RACTrac survey revealed that hospitals appealed 50% of claims denied by Recovery Audit Contractors (RAC) during the first quarter 2014, according to AHA News.
 
The AHA received responses from 1,165 hospitals. The majority of claims contested by respondents’ hospitals (63%) are still in the appeals process. However, half of respondents said their hospitals were able to overturn a denial in their favor during the discussion period before a formal appeal in the first quarter. The cost of managing the RAC process during the first quarter exceeded $10,000 for 69% of hospitals responding, whereas 47% spent upwards of $25,000.
 
Respondents attributed the majority of RAC denials to inpatient coding errors and lack of medical necessity. Respondents from more than half of the hospitals surveyed (59%) said that RACs denied their claims due to inpatient coding errors. These denials increased 8% during the last quarter. Similarly, two-thirds of respondents (66%) attributed short-stay medical necessity denials at their hospitals to placing patients in the wrong setting.
 
For information about appealing denied claims and developing an internal appeals process, join Mark Michelman, MD, MBA, and Stacey Levitt, RN, MSN, CPC,  at 1 p.m. (Eastern) Thursday, August 7, for HCPro’s 90-minute live webcast, Medicare Appeals Made Easy: A Focus on Reducing Denials.

 



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