Health Information Management

CMS raises limits for RAC additional documentation for certain providers

HIM-HIPAA Insider, September 6, 2011

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As of August 22, recovery auditors can request up to 35 records per 45 days from non-supplier and non-physician Medicare providers.

The new limit allows RACs to request one more record from providers that were previously limited to 34 additional documentation requests or fewer. CMS set the limit equal to 1% of all claims submitted for the previous calendar year, divided by eight. RACs may go more than 45 days between record requests, but may not make requests more frequently than every 45 days. In addition, a provider’s limit will be applied across all claim types, including professional services, according to the CMS release.
 
While the new limit change may not represent much of a change for most facilities, some providers out there should take note, according to Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc.
 
“This will affect critical access hospitals and other small rural hospitals,” she says. “That one chart, although it sounds minimal, can have a lot more impact on these types of providers who already operate with minimal staff wearing multiple hats.”
 
Editor’s note: View the article on the Revenue Cycle Institute website.



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