Coding & Compliance - March/April 2010
“Recent RAC (Recovery Audit Contractor) Updates”
CMS has expanded FY 2010 RAC Additional Documentation Request (ADR) limits to all Institutional Providers. The limits and methodology which previously applied only to requests for DRG validation purposes will now be used for reviews of all institutional claims. Per CMS, the limits for physicians, non-physician practitioners and DMEPOS suppliers will be posted at a later date.
The additional documentation request limits for the RAC program for institutional providers will be set by each RAC on an annual basis to establish a cap “per campus” on the maximum number of medical records that can be requested per each 45 day period.
A campus unit can consist of one or more separate facilities/practices under a single organization umbrella, with each limit based on that particular unit’s prior fiscal year CMS claims volume. Limits will be set at 1% of all claims submitted for the previous calendar year divided into 45 days. Each RAC may go more than 45 days before requesting records but they cannot request more frequently than every 45 days.
Additional changes for FY 2010:
- Through March 2010, the cap will remain at 200 additional documentation requests per 45 days for all providers/supplers.
- April 2010 through September 2010 - Providers/suppliers who bill in excess of 100,000 claims to CMS (per TIN) will have a cap of 300 additional documentation requests per campus unit, per 45 days.
- RACS can request permission to exceed the cap on a case by case basis. Any affected providers will be notified prior to receiving any additional requests.
Additional information regarding the RAC updates can be obtained at: RAC@cms.hhs.gov.
Click here for a printable version of this newsletter: CCMar2010
If you have any questions or need additional information regarding this article please contact Cindy Tipton at Cindy_Tipton@MED3000.com
