RAC audits are good at ferreting out information on what hospitals are doing “wrong”, but the study that Sheehy et al published on the actual impact of RAC audits and their outcomes is eye opening. Below are some of the highlights from their work:
• RACs alleged non-compliance — all overpayments — for 31% of the cases they requested.
• Hospitals disputed just about all the cases — 91%.
• Hospitals employ more than five full-time staff to deal with the audit process
• The care provided was never disputed, just the fact that it was provided in an inpatient rather than outpatient or other setting.
• More than 16% of cases are still pending, more than 555 days after their appeal.
• Some from 2010 and 2011 spent more than 900 days in appeal.
• Hospitals won an increasing number of cases as the years progressed, going from 36% in 2010 to 68% in 2013.
• Half the time, hospitals withdrew appeals or rebilled during the discussion phase of the case.
• Half the cases have been won in discussion or appeal over the four year period of the study.
• A third of cases are decided in favor of the hospital in the discussion period.
• A two-fold increase in audits and 300% increase in overpayment determinations during the last two calendar years of the study at all three hospitals.
• Just 18 cases were conceded by hospitals due to missing a filing deadline.
1. Sheehy AM, Locke C, Engel JZ, Weissburg DJ, et al. Recovery Audit Contractor audits and appeals at three academic medical centers. J Hosp Med. 2015 Apr;10(4):212-9. doi: 10.1002/jhm.2332.
