Revenue Cycle

Recovery Auditors to increase medical records request limits

Recovery Auditor Report, March 22, 2012

On March 12, CMS issued an update that effectively raises the additional documentation requests (ADR) limits for Recovery Auditors. Beginning March 15, 2012, ADR limits will increase to 2% of all claims submitted in the prior calendar year, divided by eight. This represents a 1% increase from 2011. In addition, the maximum number of requests per 45 days is now 400, which is an increase of 100 from last year. Providers with more than $100 million in MS-DRG payments that previously had a 45-day cap of 500 now have a new cap of 600 record requests per period. For those providers that have a calculated limit of 34 ADR requests or less, the Recovery Auditors may requests up to 35 records per 45-day period.

Other relevant announcements within the update include the fact that CMS still reserves the right to allow Recovery Auditors to exceed stated limits, at CMS’ discretion or by Recovery Auditor request. In these cases, CMS or the Recovery Auditor will notify affected provider in writing.

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