CMS Corrects Improper Payment Figures, Statistics

James Carroll, for HealthLeaders Media , June 19, 2012

To further reinforce the decision to appeal an overturned case, consider the fact that of the 24,458 cases that were successfully appealed cases, that $37.9 million, or approximately $1,550 per case, was overturned in 2011.  
Overall, providers should consider the fact that there is a large amount of claim denials that should be appealed, according to Deborah Hale, CCS, CCDS, president and CEO of Administrative Consultant Service, LLC, in Shawnee, OK.

"I'm surprised at the low appeal rate given the volume of denials that I see that clearly warrant appeals," says Deborah Hale. "This may be in part due to frustration with the process, an increased workload for hospitals associated with ICD-10 preparation and training, implementation of electronic health records, and the multitude of other high-priority projects, such as patient care, that hospitals are facing this year."

To view the latest Recovery Auditor report, click here. To view the previous report, click here. To view the June 2012 appeals update, click here. To stay on top of the latest RAC-approved issues in your state, visit the Revenue Cycle Institute website.


James Carroll is associate editor for the HCPro Revenue Cycle Institute.
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