RAC medical record requests up 47%

Requests for medical records from Medicare recovery auditors (RACs) are up 47 percent since 2012's fourth quarter, according to an American Hospital Association survey of more than 12,000 hospitals.

The survey found during the second quarter of 2013, complex audit denials by Medicare RACs rose 58 percent, with two-thirds of hospitals reporting the most expensive RAC requests are medical necessity denials.

The survey also found nine out of 10 hospitals said they experienced RAC activity in the first half of the year. Sixty-three percent report they spent more than $10,000 on the RAC process in the second quarter of 2013. Forty-five percent reported spending more than $25,000 on the same process while 11 percent reportedly spent more than $100,000.

Of the medical necessity denials reported, 62 percent were not because the care itself was unnecessary, but because of one-day stays in the wrong place. Sixty-three percent of hospitals reported appealing short stay denials. Overall, hospitals reported appealing 40 percent of all RAC denials. Approximately three-quarters of appealed claims remain in process.

Most RAC activity was in RAC region C, which is primarily made up of Southeastern states.  

These results are similar to those of the RACTrac survey for the fourth quarter of 2012, which found that 90 percent of respondents had experienced RAC activity, up from 89 percent in the third quarter. Short stay denials also were the most common form of denial in the fourth-quarter survey.

To learn more:
-here's the RACTrac survey