CMS places limits on recovery audit contractors in 2010
Published: 2009-12-13 19:43:57
Author: Health Imaging | December 11, 2009
The Centers for Medicare & Medicaid Services (CMS) has placed limits on recovery audit contractors (RACs), regarding the number of medical and related claims record requests they may seek from hospitals and other providers during an audit in 2010.
The agency said it made this decision in response to feedback from the RACs, providers/suppliers and their associations. These limits will be set by each RAC on an annual basis to establish a cap per campus on the maximum number of medical records that may be requested per 45-day period.
The limits will be set at 1 percent of all claims submitted for the previous calendar year, and divided into eight periods (45 days). Although the RACs may go more than 45 days between record requests, in no case shall they make requests more frequently than every 45 days, according to CMS. A provider’s limit will be applied across all claim types, including professional services.
The agency added that the limits are based on submitted claims, irrespective of paid/denied status and/or individual lines, although interim/final bills and RAPs/final claims shall be considered as a unit.
While respecting a provider’s overall limit, CMS said that the “RAC may exercise discretion in the exact composition of an additional documentation request.” For example, the RAC may request inpatient records up to the full limit even though the provider’s inpatient business may only be a small portion of their total claim volume.
Full story
Published: 2009-12-13 19:43:57
Author: Health Imaging | December 11, 2009
The Centers for Medicare & Medicaid Services (CMS) has placed limits on recovery audit contractors (RACs), regarding the number of medical and related claims record requests they may seek from hospitals and other providers during an audit in 2010.
The agency said it made this decision in response to feedback from the RACs, providers/suppliers and their associations. These limits will be set by each RAC on an annual basis to establish a cap per campus on the maximum number of medical records that may be requested per 45-day period.
The limits will be set at 1 percent of all claims submitted for the previous calendar year, and divided into eight periods (45 days). Although the RACs may go more than 45 days between record requests, in no case shall they make requests more frequently than every 45 days, according to CMS. A provider’s limit will be applied across all claim types, including professional services.
The agency added that the limits are based on submitted claims, irrespective of paid/denied status and/or individual lines, although interim/final bills and RAPs/final claims shall be considered as a unit.
While respecting a provider’s overall limit, CMS said that the “RAC may exercise discretion in the exact composition of an additional documentation request.” For example, the RAC may request inpatient records up to the full limit even though the provider’s inpatient business may only be a small portion of their total claim volume.
Full story