Health Information Management

News: AHA releases first quarter 2011 RACTrac report

CDI Strategies, May 26, 2011

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Recovery Audit Contractors (RAC) reported doubled its recovery amounts since last quarter—$167 million in denials during the first quarter of 2011 up from $86 million reported during the last quarter of 2010, according to the May 2011 RACTrac survey results released by the American Hospital Association (AHA).

Ninety-five percent of denials stem from complex denials totaling over $158 million, with most respondents citing medical necessity as the primary reason. Of these, the majority reported denials for one-day stays where RACs determined that the care was provided in the wrong setting, not necessarily because the care was unwarranted, the report states.
Syncope and collapse was reported as the top MS-DRG denied across the more than 1,900 survey participants for both medical necessity and incorrect coding denials.
Hospitals reported appealing one in four denials with a 71% success rate and nearly three of every four records reviewed did not have an improper payment associated with it, the report states.

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