Part A redeterminations skyrocket

First-level appeals of Part A Medicare claims for hospital inpatient care and home healthcare have zoomed between 2008 and 2012, while rulings in favor of providers have declined dramatically, AHA News Now reported.

According to a report from the Department of Health and Human Services' Office of the Inspector General (OIG), the number of first-level appeals for inpatient claims, known as redeterminations, rose five-fold between 2008 and 2012. They increased seven-fold for home healthcare claims, according to AHA News Now.

Medicare claims administration contractors handle redeterminations. If they reject the appeal, providers have a variety of options for pursuing further appeals.

Meanwhile, the percentage of such redeterminations that were in the favor of providers dropped from 83 percent in 2009 to 11 percent in 2012. During last fiscal year, RAC auditors collected more than $2.2 billion in overpayments.

Altogether, Medicare contractors processed 2.9 million redeterminations last year involving 3.2 million claims, up 33 percent since 2008, the year before RAC auditing began. Eighty percent of first-level appeals involved Part B claims, which typically are for smaller sums than Part A claims. But appeals involving RAC audits comprised 39 percent of all redeterminations last year, according to the OIG.

To learn more:
- read the AHA News Now article
- download the report (.pdf)

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