Dive Brief:
- An ongoing survey by the American Hospital Association has concluded that nine out of 10 hospitals participating had been approached by Recovery Audit Contractors during the third quarter of 2013, a similar level to that seen in the second quarter.
- The survey found that of 2,452 hospitals responding, 2,164 reported RAC activity through the end of September 2013, with 68% of hospitals spending more than $10,000 managing the process during Q3 '13.
- Cumulative medical records grew by 13% since the first quarter of 2013, and cumulative complex audit denials reported went up 28% during the same period; Also, hospitals reported $2.5 billion in denials through the third quarter.
Dive Insight:
RAC activity, though painful, might sound reasonable to an outside viewer—after all, CMS does need to be sure Medicare payments are legit, right? he reality, however, from what we've seen, is that RACs are persecuting the innocent as well as the guilty. After all, as the survey notes, 56% of records reviewed during the third quarter didn't contain an improper payment. It's also well known that a high percentage of RAC determinations are reversed during appeal. It seems pretty clear to this editor, as it has for years now, that the RACs need to be reigned in.