Health Information Management

Hospitals appealing nearly half of RAC denials

HIM-HIPAA Insider, December 22, 2014

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The American Hospital Association’s (AHA) December 12 quarterly RACTrac survey revealed that nearly half of hospitals surveyed (48%) appealed a Recovery Audit Contractor (RAC) denial, according to AHA News.

The AHA surveyed 1,037 hospitals for the third quarter of 2014 RACTrac survey. Respondents reported a 70% overturn rate for the appeals process. More than half (59%) of respondents’ appealed claims are still in the midst of the appeals process.
The percentage of respondents whose hospitals have outpatient coding denials increased from 10% in the first of 2014 to 28% in the third quarter.
More than half of hospitals (58%) spent upwards of $10,000 managing the RAC process during the third quarter 2014 compared to 69% in the first quarter. Similarly, the percentage of respondents that spent more than $25,000 to manage this process decreased from 47% in the first quarter to 39% in the third-quarter. Just 9% of respondents spent more than $100,000 managing the RAC process during the third quarter.


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