CHANCES OF SUCCESS IN APPEAL OF DENIED MEDICARE CLAIMS

According to the American Hospital Association in its RACTrac Survey, hospitals have had a reasonable chance of overturning denied claims:

  • Basic appeal rate:  49%
  • Percentage overturned: 64%

In the period October 1, 2009 to September 30, 2011, the RACs tagged 1.1 million claims with overpayments.

  • Number appealed:  6%
  • Success in overturning appealed claims: 44%

Based on data from Office of Inspector General in a 2013 report on RACs: Medicare Recovery Audit Contractors and CMS’s Actions to Address Improper Payments, Referrals of Potential Fraud, and Performance (August 2013, OEI-04-11-00680)