HCPro, JustCoding Outpatient - 2015 Issue 48 (December)
Healthcare News: Outpatient coding and billing errors lead to most automated denials, survey shows
December 23rd, 2015
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Article Overview
This news item reviews survey results from the American Hospital Association’s RACTrac program about Medicare recovery audit denials affecting hospitals. It focuses on broad denial trends, the relative impact of outpatient billing and coding issues versus other coding-related problems, and reported changes in denial amounts and appeal outcomes over time. The article is relevant to hospital revenue cycle staff, coders, billers, and compliance teams who track denial patterns and audit activity.
Why This Topic Matters
Understanding denial patterns helps hospital coding, billing, and compliance teams monitor operational risk, prioritize review efforts, and compare current performance with prior survey periods. The article provides high-level context for denial management and audit preparedness without serving as a procedural coding guide.
What You Will Learn
- How the AHA RACTrac survey characterizes automated and complex denial trends
- What broad categories of hospital coding and billing issues are associated with denials
- How reported denial amounts and appeal-related outcomes changed over the survey periods
- Why hospital revenue cycle and compliance teams monitor RACTrac findings
Who Should Read This
- Hospital coders
- Medical billers
- Revenue cycle staff
- Compliance teams
- Health information management professionals
- Hospital administrators
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