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AHA Survey Shows RAC Denials Up in 2nd Quarter

On August 22, 2012 the American Hospital Association (AHA) published the results of a survey which indicates that Recovery Audit Contractor (RAC) claim denials were up in the second quarter of 2012 from the first quarter. The results of the survey include data collected from more than 2,000 hospitals nationwide.

The survey reveals that hospitals saw an increase in RAC denials in the second quarter of 2012 of 24%. Additionally, medical record requests rose 22% and the dollar value of claims denied increased 21%. Hospitals reported Short Stay Medically Unnecessary as the most common reason for denial. According to the survey 70% of denials were listed as Short Stay Medically Unnecessary, which is a rise of 1% from the first quarter of 2012.

Hospitals are spending an increasing amount on RAC issues. In the second quarter of 2012, 55% of the hospitals in the survey indicated they spent more than $10,000 on RAC issues. Hospitals also spent an average of $24,064 on external legal counsel in the same quarter.

At Wachler & Associates, P.C. we have extensive experience in appealing short stay cases denied as medically unnecessary and securing Part B payment where Part A is denied. If you need assistance defending a RAC audit, or need help developing a proactive compliance program in anticipation of the increased audit activity, please contact an experienced Wachler & Associates healthcare attorney at 248-544-0888.