Revenue Cycle

Dig out your calculators: CMS announces RAC medical record request limitations

Recovery Auditor Report, November 13, 2008

On October 30, CMS announced limitations on the number of medical records RACs could request for fiscal year 2009 on the CMS Web site.
  • Inpatient hospitals, inpatient rehabilitation facilities, skilled nursing facilities and hospices. RACs may request up to 10% of the average monthly Medicare claims (maximum of 200) every 45 days.
The CMS Web site provides the following example:
A Major Medical Center has 12,000 Medicare paid claims in 2007
  • 12,000 claims divided by 12 (months in a year) = avg 1,000 paid claims/month
  • 1,000 paid claims/month x 10% = 100
Therefore, the limit a RAC may request from the medical center is 100 medical records per 45 days
  • Outpatient hospitals, home health and other types of Medicare Part A billers. RACs may request 1% of the average monthly Medicare services (maximum of 200) ever 45 days.
The CMS Web site provides the following example:
A provider has 360,000 Medicare paid services in 2007
  • 360,000 services divided by 12 (months in a year) = avg 30,000 paid services/month
  • 30,000 paid services/month x 1% = 300
However, a RAC may request a maximum of 200 medical records per 45 days because it may not request more than 200 records per 45 days.
  • Physicians. The number of records a RAC may request from a physician practice depends on the size of the practice. For example, a RAC may request a maximum of 10 records from a solo practitioner, whereas it may request a maximum of 50 records from a large group of more than 16 individuals.
  • Other Medicare Part B billers (e.g., DMEs, labs). RACs may request 1% of the average monthly Medicare services (maximum of 200) ever 45 days. 
For more information on the medical record request limitations, click here.

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