Revenue Cycle

Prepayment review demonstration begins; CDI role in audit defense gains momentum

Recovery Auditor Report, November 1, 2012

Editor’s note: This article originally appeared in the CDI Journal.

The AHA reports that 88% of hospitals have received an audit, according to its second quarter RACTrac report released in August (www.aha.org/advocacy-issues/rac/ractrac.shtml). Furthermore, medical record requests increased 22% over the first quarter of 2012 and the number of denials increased 21%.

Eighty-four percent of AHA survey respondents indicated that medical necessity denials represented the most costly and complex form of denials. More than 50% indicated they spent roughly $10,000 managing the Recovery Auditor (RAC) process during the second quarter—9% say they spent more than $100,000.

Despite the cost, when hospitals appeal their denials they typically win. The RACTrac report indicates that hospitals appeal more than 40% of their denials with a roughly 75% success rate.

That’s where CDI professionals come in.

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