The late Marvin Gaye’s 1971 hit “What’s Going On?” gives us reason to pause in contemplating two reports this week on the Centers for Medicare & Medicaid Services’ RAC program.

The RACTrac report researched and published by the American Hospital Association for the third quarter of 2013 reveals that the RAC program is far from successful. The report notes that $9.4 billion in Medicare payments were targeted for medical record requests. Of those, 58 percent had no improper payments. Couple that with the fact that hospitals stated they spent as much as $100,000 in the administrative management of the RAC program.

In our own survey, conducted recently by Frank Cohen of the Frank Cohen Group, RACmonitor respondents were asked about appealing these denials and/or adjustments. More than 50 percent of respondents said they appeal between 90 and 100 percent of those claims. Cohen wrote, “on appeal, upward of 80 percent of these are overturned in favor of the provider.”

Now comes the OIG report this week that says in fiscal years 2010 and 2011, the RACs could identify only half of all the claims as having improper payments—a sum of $1.3 billion.  

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