Health Information Management

News: Recovery Auditor activity intensifying

CDI Strategies, March 14, 2013

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Recovery auditor recoupments increased 14% since 2012, according to the 2013 Recovery Auditor Benchmarking report from The Revenue Cycle Institute. In addition, the percent of providers which reported receiving record requests for complex or semi-automated reviews increased from 82% to 91%. The latest report also illustrates the growth of RA prepayment audit initiates with 74% of the 325 respondents indicating they had received a prepayment review either from their Medicare Administrative Contractor (52%), their RA (6%), or both (16%).

The American Hospital Association (AHA) released its RACTrac survey, assessing RA activity for the fourth quarter 2012, on March 8. Its analysis also indicates increasing RA activity with 720,590 medical record requests, 233,769 complex denials, and 58,426 automated denials. Automated denials actually decreased from a reported 64,577 in third-quarter 2013. The AHA report shows continued emphasis on medical necessity denials but indicated that nearly two-thirds of these denials were for care provided in the wrong setting, not because the care was unnecessary. Survey respondents appealed 41% of denials with a success rate of 72%.

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