News: AHA releases results from RACTrac for first quarter 2016

CDI Strategies - Volume 10, Issue 28

By Melissa Varnavas

Recovery Auditor medical record requests and automated and complex denials all fell slightly in the first quarter of 2016, as did the average number of medical record requests per hospital, which decreased slightly since the fourth quarter of 2015, according to the latest RACTrac report from the American Hospital Association (AHA).

Automated denials principally related to outpatient billing errors while hospitals reporting complex denials indicated that inpatient coding was at fault, the report states. While facilities seem to be spending less on the appeals process and managing Recovery Auditor denials processes, at least 8% of hospitals reported spending more than $100,000 on the effort.

As the current round of Recovery Auditor contracts close, CMS calls on contractors to complete any outstanding claim reviews, and reminded providers of important dates. For example, May 16 marked the last day that a Recovery Auditor could send Additional Documentation Request (ADR) letters or semi-automated notification letters and yesterday, June 29, was the last day to notify providers of improper payments, according to information on the government’s website. Contractors also need to complete all discussion periods by August and send any claim adjustment files to the Medicare Administrators Contractors by October 1.

A severe backlog of appeals, related to the Recovery Auditor efforts gave rise to numerous legal battles over the years. On June 28, the Department of Health & Human Services (HHS) released a proposed rule changing the Administrative Law Judge appeals process, according to AHA NewsNow.

The HHS proposal could allow appeals to come before attorney adjudicators and/or allow the department’s appeals board to “designate certain decisions as precedential.”

“We are skeptical that these proposals will do more than scratch the surface of the severe backlog in ALJ appeals that has led to hospitals facing multi-year waits for hearings,” said AHA Executive Vice President Tom Nickels, in the NewsNow article, calling the timing of the release of the proposed rule “interesting” coming days ahead of an expected HHS in-court response to the appeals backlog.