Recovery audit contractors denied $2.47 million in Medicare claims to 437 hospitals in the first quarter of 2010, the American Hospital Association
announced.
In the first results of its RACTrac survey, a quarterly poll designed by the AHA to track and summarize the RAC program's impact, the AHA determined that the RAC contractors were engaging primarily in complex reviews, which use human review of medical records and other medical documentation to identify improper payments to providers.
“Outpatient coding and billing were often the target for automated reviews, while inpatient coding was a common target for complex reviews,” the survey stated. RAC respondents reported complex reviews of medical records totaling more than $117 million nationwide.
The Recovery Audit Contractor, or RAC, program allows third-party auditors hired by the CMS to keep 9% to 12.5% of payments they identify as improper and collect from providers. Currently, it only audits payments made in Medicare's fee-for-service program.
At least in the first quarter of this year, the RAC program has affected 84% of responding hospitals—whether or not they experienced RAC reviews, the AHA determined.
Data for the RACTrac's first quarterly survey was conducted April 1-22. More than 650 responses were received, with 437 reporting RAC activity.
