News: AHA survey reveals 60% of RAC reviewed claims did not have overpayment

Hospitals continue to appeal Recovery Audit Contractor (RAC) claim denials, according to the latest report from the American Hospital Association’s quarterly RACTrac survey.

Hospitals reported appealing 45% of all RAC claim denials, and 60% of claims reviewed in the second quarter of 2016 had no overpayment. Hospitals also reported that RACs cite “inpatient coding errors” as the most common reason for complex claim denials.

Three in four claims appealed to an administrative law judge took longer than the statutory limit of 90 days to provide a determination to the hospital, according to the report.

The AHA RACTrac survey collects data from hospitals on a quarterly basis to assess the effect of the Medicare RAC program on hospitals nationwide. The AHA developed RACTrac in response to the lack of data and information provided by CMS on the effect of the RAC program on providers.

Hospital representatives are invited to attend a webinar October 18 at 2 p.m. eastern 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. All hospitals can submit their third quarter data to the RACTrac survey through Oct. 21.