Health Information Management

News: Latest AHA Recovery Auditor survey shows losses on outpatient and inpatient services

CDI Strategies, February 11, 2016

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Outpatient coding and billing errors led to more than half of all automated denials by Recovery Auditors, according to the latest RACTrac survey from the American Hospital Association (AHA). Outpatient errors increased by 10% from its third quarter 2014 survey with the nationwide average takeback increasing from $688 in 2014 to $1,056 in 2015.
Complex denials, however, came from incorrect MS-DRG assignments or other coding mistakes. Although the average dollar amount denied due to complex reviews fell, it fell by a mere $200 from $5,618 in 2014 to $5,458 in the most recent survey.
The rate of hospitals with denials reversed (those facilities which contested the denial and won their appeals) during the discussion period fell, too, from 52% in 2014 to 45% in 2015. But the number of denials available for appeal also fell, from 540,203 to 366,479 over the same time period. Claims overturned in favor of the provider after completing the claims process have also fallen from 70% last year to 62% in 2015.


Editor’s Note: Portions of this article were adapted from the APCs Insider e-newsletter.  

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