AHA survey quantifies RAC medical necessity denials, hospital appeal success

AHA News Now

Medical necessity denials are the top reason Medicare Recovery Audit Contractors have denied claims since first-quarter 2010, according to 2,220 hospitals responding to the AHA's RACTrac survey. The majority of these medical necessity denials were for one-day stays found to be in the wrong setting, not because the care was medically unnecessary. The latest RACTrac report also reveals that when hospitals choose to appeal RAC denials, they win 75% of the time. Hospital respondents also report that over two-thirds of medical records reviewed by RACs did not contain an improper payment. Hospital representatives are invited to attend a free June 27 webinar on the survey results and how to participate in the free web-based survey, which helps hospitals monitor the impact of RACs and advocate for needed changes to the program. For more information, visit www.aha.org/aha/issues/RAC/ractrac.html.

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