MACs vs. RACs: Could Competition Mean More Bad News for Providers?

There was a 98.8% level of care error rate, according to the audit, meaning TrailBlazer recouped reimbursement in 98% of cases. "For most hospitals, that amount is in the $12,000 range," Hale said. "That's a pretty nice slice of reimbursement, and that leaves the hospital having to donate that drug-eluting stent at no charge."

(The MAC denied 87% of the cases because it believed the provider should have performed the procedure in an outpatient, rather than inpatient setting. Another 11% were denied because providers didn't submit requested medical records.)

And that's not all. During a recent HCPro focus group call, one healthcare provider recently reported seeing a 70% increase in audit activity by commercial payers at their facility.

Just what every provider wants—more audits.