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Ask the right questions regarding RAC records requests

HIM Connection, October 6, 2009

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Inpatient hospitals, inpatient rehabilitation facilities, skilled nursing facilities, and hospice centers may receive request for 10% of their average monthly Medicare claims (maximum 200) every 45 days.

To plan for RAC record request, HIM directors should ask the following questions:

• What is our volume of claims that fall under each RAC-identified issue? If you have a large number of claims that fall into one of these categories, your RAC could request large numbers of records.
• Do we need to hire additional staff members? You must determine who is going to handle the requests and depending on how many you’re receiving, you may need to hire additional staff.
• Will we require staff members to review records before we send them to the RAC? Reviewing records may add to process time, but it may also ensure each response is complete.
• Who will we assign to process record requests? It is important to identify a key person to handle the requests and meet the 45-day response time requirement.
• Will we monitor the total number of requests we receive every 45 days? Ensure RACs do not exceed the 200 records per 45 days limit by tracking requests in a database.
• How will we respond when a record request includes information about a new issue? Ensure that no compliance issues exist in that area and use the information as a predictor for future audits.
• Which format should we use when responding to record requests? CMS requires RACs to accept paper records and scanned images on a CD or DVD. In 2010, they will also have to accept imaged records electronically. Do not send your records in more than one format. Ask your RAC about guidelines for sending in CDs or DVDs (i.e., do they prefer PDF or TIF files?).
• Will we retain a copy of records we send to the RACs? Retaining copies is helpful in case the RAC doesn’t receive them. It also could help with appealing denials.

Editor’s note: This tip was adapted from the July issue of Medical Records Briefing.

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