RAC Activity on the Rise All Around
Providers aren’t the only ones spending more time digging up material for recovery audit contractors (RACs). Hospitals report rising rejections of claims connected to RAC audits. Some of those rejections have prompted the Centers for Medicare & Medicaid Services (CMS) to adopt new rules about observation care.
Industry publication AHA News Now reports the American Hospital Association’s RacTrac survey finds the number of RAC requests grew 13 percent since the first quarter of the year, while complex audit denials climbed 28 percent. The AHA said the average dollar value of a denial was $5,663.
The hospital organization says 97 percent of hospitals surveyed reported some activity, while the number of hospitals reporting RAC activity rose by 5 percent from the 2nd to 3rd quarters of 2013.
The RacTrac survey says the biggest issue causing denials was short-hospital stays deemed unnecessary. This prompted the “two midnight” billing rule, which mandates if a patient stays two midnights, a hospital must bill the care under Medicare Part A.