Revenue Cycle

AHA issues Member Advisory on RAC program

Recovery Auditor Report, April 30, 2009

With so many Medicare reimbursement dollars at stake, it is no surprise that everyone is putting in their two cents. Make no mistake—the wealth of information becoming available is a good thing. The more you know about the RAC program, the better you will be able to manage the process.
Most recently, the American Hospital Association (AHA) is sharing what it knows via a Member Advisoryreleased April 20. The publication, “Medicare Recovery Audit Contractors (RACs): Permanent Program Basics,” (available to AHA members on the organization’s Web site) contains a wealth of RAC-related information for healthcare providers.
“With the RAC program in the process of rolling out nationally, it is crucial for hospital executives to use tools like this to help educate themselves on the permanent program,” explained Robert Corrato, MD, MBA, founder, president and CEO of Executive Health Resources. “There have been some changes since the RAC demonstration which we have seen result in confusion for many hospitals across the country.”
While the Advisory discusses a wide variety of RAC-related topics, healthcare providers may find useful the information on medical record request limits—a topic many organizations find confusing. And CMS has left its options open to alter the current medical record request limits in the future. Interestingly, the AHA notes that while hospital campuses with more than one NPI are currently capped at 200 medical records per 45 days, this could change. “[CMS] will be looking at organizations with multiple NPIs closely to ensure that the organizational structure does indeed warrant a cap of 200 medical records. It is not CMS’ intent to have multi-hospital systems subject to a cap of 200 medical record requests per 45 days,” according to the Advisory.
The AHA also notes that RACs may not “supersede” medical record request limits by “bunching” requests. In other words, think of cell phone plans featuring rollover minutes. Unlike such a plan, RACs can’t store unused requests and roll them over for later use. “If the medical record request limit for a particular provider is 50 per 45 days and the RAC does not request medical records in January and February, the RAC cannot request 150 records in March,” explains the Advisory.

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