Updated on: June 22, 2012

Medical Necessity Denials Tops AHA List

Original story posted on: June 5, 2012

Medical necessity denials are the top reason Medicare Recovery Audit Contractors have denied claims since first-quarter 2010, according to 2,220 hospitals responding to the AHA's RACTrac survey.


The majority of these medical necessity denials were for one-day stays found to be in the wrong setting, not because the care was medically unnecessary.

The latest RACTrac report also reveals that when hospitals choose to appeal RAC denials, they win 75 percent of the time. Hospital respondents also report that over two-thirds of medical records reviewed by RACs did not contain an improper payment.


About the Author


Janis Oppelt is an editor with Medical Learning, Inc. (MedLearn), a Panacea Healthcare Solutions Company, St. Paul, MN.


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