CMS releases RAC FAQ regarding 60-day determination requirement
HIM-HIPAA Insider, February 1, 2011
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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.
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