Health Information Management

CMS releases RAC FAQ regarding 60-day determination requirement

HIM-HIPAA Insider, February 1, 2011

Want to receive articles like this one in your inbox? Subscribe to HIM-HIPAA Insider!

On January 13, CMS released a new recovery audit contractor (RAC) FAQ regarding the requirement for RACs to make determinations within 60 days from when they receive medical records.

CMS provides the following information:
 
Q: What happens if the recovery auditor does not meet the 60-day requirement?
 
A: The recovery auditors have 60 days from receipt of the medical records to make a determination and issue a written notice of that determination to providers. The 60-day requirement can be found in the Statement of Work used in the Recovery Audit Program. Lack of adherence to the 60-day requirement of notification does not negate the improper payment finding or the recoupment of the improper payment by CMS. Lack of adherence to the 60-day requirement is a performance issue between CMS and the recovery auditor.
 
Click here to access the FAQ. For additional information on RACs, visit the CMS RAC website at www.cms.gov/rac.



Want to receive articles like this one in your inbox? Subscribe to HIM-HIPAA Insider!

Most Popular