CMS sets limits on RAC 'additional documentation' request for 2010

CMS this year will limit the number of additional documentation requests--such as medical records and claims records information--that Recovery Audit Contractors can seek from hospitals over a 45-day period.

The 2010 RAC limits will be set at 1 percent of all claims submitted for the previous calendar year (2008), divided into eight periods (45 days). Although the RACs may go more than 45 days between record requests, they won't be able to request the information more frequently than every 45 days, CMS recently announced. A provider's limit will be applied across all claim types, including professional services.

For example, if a provider billed 156,253 claims in 2008, the additional documentation limit would be one percent of 156,253 (1,563), divided by eight periods, for a total of 195 additional documentation requests per 45 days.

The RACs can, however, ask CMS for permission to exceed the cap on a case-by-case basis. "Affected providers will be notified prior to receiving additional requests," CMS says.

CMS says it placed the limits on the RACs "in response to feedback from the RACs, providers/suppliers and their associations."

The announcement will no doubt be good news to hospitals like Bon Secours St. Francis Health System, which recently appealed the bulk of some $2 million that RACs had denied during the RAC demonstration project, according to Hospital Case Management newsletter.

For more information:
- read the CMS announcement

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