86
CFO
/
FINANCE
Medicare Audits Up
936% in Last 5 Years
By Brooke Murphy
T
hird party recovery audit contractors are harnessing the pow-
er of big data and analytics to dramatically grow their auditing
capabilities, reports RACmonitor.
Specifically, RAC auditors are using computerized techniques to
pick targets for audits. is enabled auditors to increase the amount
of audits they can perform by 936 percent. According to RACmon-
itor, an entire industry has emerged that specializes in processing
Medicare claims data and finding "sweet spots" on which RACs can
focus their attention.
RACs have designed and patented IT systems with algorithms that
comb through hundreds of thousands of provider claims informa-
tion per minute looking for chances to downgrade diagnosis-related
group codes.
Downgrading DRG codes reduces the reimbursement amount owed
to providers. is can significantly impact hospitals' revenue.
Hospitals hit with thousands of DRG code downgrades can file an
appeal in the Medicare appeals system. However, the cost RACs in-
cur running the audit is a thousand times less expensive than what
hospitals must spend in time and money to refute the downgrades.
Hospital and healthcare advocates have argued that using statistical
analysis to downgrade medical claims does not account for the real-
ity of the patient's condition or medical treatment. n
Ascension's Expansion
Efforts Pay Off as
Operating Surplus Swells
to $753M
By Ayla Ellison
S
t. Louis-based Ascension reported $21.9 billion in rev-
enue in fiscal year 2015, up 6.6 percent from revenue
of $20.5 billion the year prior, according to financial
documents filed with bondholders.
The financial boost was partially attributable to an increase
in patient volume due to Ascension's expansion efforts in
the past year. During the year ended June 30, 2016, Ascen-
sion acquired Glendale, Wis.-based Wheaton Franciscan
Healthcare and added hospitals in Michigan and Tennes-
see as well.
Including these recently acquired facilities, the nonprofit
system said inpatient admissions and inpatient surgeries
increased 3.2 percent and 3.3 percent, respectively, as
compared to the year prior. Ascension also said emergen-
cy room visits increased 3.7 percent year over year.
After accounting for a year-over-year increase in ex-
penses of 6.1 percent, Ascension ended FY 2015 with
an operating surplus of $753.2 million, up from $696.5
million the year prior. n
BECKER'S
HOSPITAL REVIEW
8
th
Annual Meeting
April 17-20, 2017
Hyatt Regency, Chicago
To Register:
call 1.800.417.2035
email registration@beckershealthcare.com
visit beckershospitalreview.com/conference/
233
Great
Hospital
and
Health
System
Leaders
speaking;
Over
300
speakers
