HCPro, JustCoding Inpatient - 2016 Issue 41 (November)
Healthcare News: Survey: More than half of reviewed claims did not have an overpayment
November 1st, 2016
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Article Overview
This article reports on an American Hospital Association RACTrac survey covering Recovery Auditor review activity in the second quarter of 2016. It highlights claim review outcomes, denial and appeal trends, timing issues at the Administrative Law Judge level, and broad categories of improper payments discussed by the AHA. The piece is relevant to hospital compliance, revenue cycle, and coding professionals who monitor audit activity and appeal patterns.
Why This Topic Matters
It helps hospitals and coding teams understand current audit trends, the volume of denials and appeals, and why internal review processes may be important for reducing audit exposure.
What You Will Learn
- How the AHA’s RACTrac survey frames Recovery Auditor review activity
- What the article says about claim review outcomes and denial trends
- How appeal activity and administrative review timing are discussed
- Which broad categories of improper payments are highlighted by the AHA
- Why self-audits are recommended in the context of outside audits
Who Should Read This
- Hospital compliance staff
- Revenue cycle professionals
- Medical coders
- Coding auditors
- Healthcare administrators
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