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Recovery Auditor Improper Payments Ratchet Up

James Carroll, for HealthLeaders Media, October 3, 2012

"It would be really interesting if CMS also showed the overturned appeal dollars against these numbers," she says. "Granted, not everyone is appealing their RAC demands (sadly); but those that do are usually successful."

According to the Q1 2012 AHA RACTrac report, hospitals that choose to appeal win 75% of the time.

"Unfunded government mandates, such as RACs, deplete sorely-needed hospital resources during a time when hospitals are seeing very slight margins of earnings," she said.

William Malm, ND, RN, CMAS, senior data projects manager for revenue integrity software company Craneware, Inc., with U.S. offices in Atlanta, Boston, Nashville and Phoenix, shared a similar sentiment, while also suggesting that CMS needs to provide additional guidance when it comes to compliant billing.

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