AHA survey: 6 in 10 RAC reviewed claims did not have an overpayment

AHA News Now

Hospitals continue to appeal Recovery Audit Contractor claim denials, according to the latest report from the AHA's quarterly RACTrac survey. Hospitals participating in the fourth-quarter 2015 survey report appealing 49% of all RAC claim denials, and 60% of claims reviewed in the fourth quarter were found to not have an overpayment. Hospitals also report that RACs cite inpatient coding error as the most common reason for complex claim denials. For more than 87% of claims appealed to an administrative law judge, the judge has taken longer than the statutory limit of 90 days to provide a determination to the hospital, according to the report. Hospital representatives are invited to attend a webinar March 22 at 2 p.m. ET to review the survey results and recent RAC policy developments. The free, web-based survey helps AHA monitor the impact of RACs and advocate for needed changes to the program. For more information, visit www.aha.org/rac.

Topic: Advocacy and Public Policy
Tags: RACs, Medicare

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