Hospitals report increased RAC activity, denials

Hospitals continue to report an increase in Medicare recovery audit contractor (RAC) payment denials, with the average facility appealing more than 80 RAC denials, reported AHA News Now.

According to the American Hospital Association's RACTrac Survey, 83 percent of the more than 2,200 hospitals surveyed had experienced some RAC activity. Among those facilities with 200 or more beds, 94 percent experienced some activity.

Through the first quarter of 2012, hospitals have reported a total of 50,395 automated denials, up sharply from the 38,444 reported through the fourth quarter of 2011. Complex denials jumped more than 50 percent, to 124,055 through the first quarter of 2012, up from 81,667 during the previous quarter.

The average number of medical records requested by RACs also rose sharply. Region A hospitals--those in the Northeast--received an average of 773 requests per facility, compared to 480 for hospitals in the other regions.

Overall, RACs targeted $1.1 billion in Medicare payments during the first quarter of 2012, compared to $876 million during the fourth quarter of 2011.

Meanwhile, a Medicare RAC prepayment audit demonstration project set to start June 1 was delayed by the Centers for Medicare and Medicaid Services, CMIO reported. The agency will give providers at least 30 days notice before implementing the RAC prepayment reviews.

To learn more:
- read the AHA News Now brief
- here's the RACTrac survey (.pdf)
- check out the CMIO article