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AHA survey shows continued increase in RAC activity

December 5, 2012

The number of Recovery Audit Contractor claim denials has increased by 23% relative to last quarter, according to the most recent results of the AHA's RACTrac survey. Medical necessity denials represent the top reason Medicare RACs have denied claims since first-quarter 2010, according to 2,307 hospitals responding to the survey; however, 61% of medical necessity denials were for claims where the RAC claimed treatment was provided in the wrong setting, not because the care was medically unnecessary. Survey respondents are currently appealing more than 40% of all RAC denials with a success rate of 74%. Hospital representatives are invited to attend a free Dec. 19 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/RACTrac.