CMS expands RAC medical record requests

The Centers for Medicare & Medicaid Services has expanded the amount of records a recovery audit contractor (RAC) may request from hospitals and skilled nursing facilities, the agency announced earlier this month.

The new annual limit for records requested every 45 days is 2 percent of all claims submitted in the prior year, divided by eight, and subject to specific caps, according to the CMS.

CMS also increased the caps on medical records a RAC may request. According to the agency, RACs may now request up to 400 medical records from a single provider during a 45-day period, up from 300. For facilities with more than $100 million in Medicare severity diagnosis-related group payments, the cap rose from 500 to 600.

But the American Hospital Association opposes the expansion. "Hospitals strive for payment accuracy and are committed to working with CMS to ensure the accuracy of Medicare and Medicaid payments; however, the flood of new auditing programs has saddled hospitals with duplicative audits, unmanageable medical record requests and inappropriate payment denials," Elizabeth Baskett, the AHA's senior director of policy, told AHA News Now.

The changes went into effect on March 15, according to a CMS bulletin.

CMS recently expanded the use of RACs from Medicare claims into the Medicaid program. According to Provider magazine, the Obama administration projected RACs will save the federal government $2.1 billion over the next five years.

To learn more:
- here's the CMS bulletin (.pdf)
- read the AHA News Now brief
- read the Provider article

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