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Hospital Report

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The premier resource for hospital professionals from Relias Media, the trusted source for healthcare information and continuing education.

What do RACs & Santa Clause have in common?

January 12th, 2015

Those who believe, receive.

This statement doesn’t apply only to children who voice skepticism about who delivers their presents on Christmas Eve. Hospitals that believe their claims are correct and should not have been denied by Medicare Recovery Audit Contractors are finding that they also receive a gift.

Hospitals are appealing nearly one-third of all Medicare RAC denials, and a whopping 77% of those are overturned in favor of the hospital, according to the American Hospital Association. However, you’d better watch out, because the RACs know if you’ve been bad or good. The no. 1 reason for denials: medical necessity claims. In a twist, the RACs aren’t saying the care was medically unnecessary. (Confusing, I know. Stick with me here.) Most of the medical necessity denials were for one-days stays that the RAC determined were in the wrong setting.

In this case, ignorance is not bliss. Most hospitals (57%) say they haven’t had any education on avoiding payment errors from CMS or its contractors. Don’t pout, however; the AHA is coming to the rescue with its bundle of toys. On Jan. 4, it’s offering a free webinar on the RAC program and the latest data from the RACTrac report. You’ll also learn how to participate in the free web-based survey, which will help you monitor the impact of RACs and become an advocate for changes to the program.

Now, speak not a word, but get straight to work building your case against the RAC denials. Happy holidays to all, and to all a good fight.