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RAC Appeals Process 'Broken,' AHA Says

Cheryl Clark, for HealthLeaders Media, January 16, 2014

"Hospitals are bearing the financial burden with over a billion dollars caught in a broken appeals process that takes several years to issue a final determination," he wrote. His letters added that since 2010, RAC denials "have increased nearly 30-fold," with the average number of appeals per hospital growing from 17 in 2010 to 300 in 2013, with $1.5 billion now at stake

In a similar letter addressed to members of Congress, Pollock wrote: "During this 30-month period in the appeals process, hospitals are not paid for the care they provided to Medicare beneficiaries."

He added that "hospitals win more than 70 percent of appealed inpatient denials, meaning that the majority of appealed inpatient claims that were denied by RACs are accurate, necessary, and supported by clinical guidelines."

One physician willing to speak out is Steven Hanks, MD, vice president of medical affairs of the 414-bed The Hospital of Central Connecticut within Hartford HealthCare. Hanks says that RAC auditors have unfairly denied 1,408 claims since 2010, holding up more than $9 million in Medicare claims going back about three years.

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2 comments on "RAC Appeals Process 'Broken,' AHA Says"


Thomas H (1/16/2014 at 1:48 PM)
This process is a nightmare I know I currently assist the RAC. Most of the high end personal dont have any clue of the process or procedures and seem to be very limited to being open to new structure or any ideas. I have been in the medical billing, collections, administrative field, etc for over 10 years now and the process needs to be fixed starting with the system upgrades and quicker transactions and either removing the sub contractors or requiring them to have a certain amount of personal. I have never been so frustrated or lost at certain times in my field until I ran into this process. I am greatful I have a job but I feel so unproductive because all the incorrect feedback and decision making. Well thats that I hope this process gets fixed quick for the better.

Karen Luther (1/16/2014 at 10:39 AM)
Thank you to the AHA for taking this stand!