Medicare RAC activity heats up

Hospitals are facing an increase in Medicare recovery auditor (RAC) activity, including dramatic upswings in denials and medical record requests, AHA News Now reported.

In fact, 91 percent of hospitals participating in the American Hospital Association's RACTrac survey experienced RAC activity during the first quarter of 2013, slightly up from 90 percent in the prior quarter.

Hospitals saw the number of medical record requests jump 53 percent from the cumulative total in the third quarter of 2012, while complex audit denials increased by 42 percent, according to the latest RACTrac survey.

Short stay medical necessity remained the top reason for complex denials at 75 percent, followed by inpatient coding at 46 percent of complex denials.

The survey also revealed timeliness issues regarding denials and medical record requests for the first quarter of 2013.

While hospitals appealed 44 percent of denials with a success rate of 72 percent, three-fourths of all appealed claims are still stuck in the appeals process. And 88 percent of participating hospitals had at least one delay longer than the statutory limit of 90 days for the administrative law judge to issue a decision on an appeal.

Moreover, for about 60 percent of hospitals, RACs requested more than two-thirds of their claims after the timely filing window passed.

The AHA survey figures follow new data from the Centers for Medicare & Medicaid Services, which show Medicare RAC collected $1.37 billion in overpayments and returned $65.4 million in underpayments in the first half of fiscal 2013.

For more:
- here's the AHA News Now brief
- check out the survey (.pdf)