Hospitals Appeal Half Of All RAC Claim Denials

According to the American Hospital Association’s (AHA) quarterly RACTrac survey, hospitals are continuing to petition CMS to overturn claim denials, despite the increasing backlog and cost of Recovery Audit Contractor (RAC) appeals. The RACTrac survey “collects hospitals’ cumulative RAC experience data from the beginning of activity through the first quarter of 2014.” In the latest survey findings, hospitals reported that they appeal 50 percent of all RAC denials with a success rate of 68%. Half of the hospitals surveyed also reported that the appeal was overturned during a discussion before the formal appeal. More than half of hospitals that filed formal appeals disputed short-stay, medically unnecessary denials. A majority of hospitals also reported that they received RAC denials for inpatient coding, an eight percent increase since last year.

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One thought on “Hospitals Appeal Half Of All RAC Claim Denials

  1. Pingback: Monday Morning Recap | hmsabc

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