CMS revises recovery audit contractor limitations

As of March 15, Medicare recovery audit contractors (RACs) can request double the number of residential medical records than previously allowed, thanks to a recent announcement from the Centers for Medicare & Medicaid Services (CMS).

As Healthcare Finance News explains, before the new rule went into effect, the annual limit for most providers was 1 percent of all claims submitted in the prior calendar year divided by eight. RACs were also restricted from requesting more than 300 medical records in a 45-day period. Now, the annual limit has doubled to 2 percent of claims, and up to 400 medical records can now be requested in a 45-day period.

The CMS increases were not received positively by some healthcare industry groups, including the American Hospital Association (AHA). In a recent statement, Elizabeth Baskett, senior director of the AHA, cited "duplicative audits, unmanageable medical record requests and inappropriate payment denials" as some of the problems hospitals have to deal with as a result of new auditing programs.

"The AHA opposes the dramatic increases in medical record request limits for the RAC program and will continue to press CMS to streamline its redundant payment auditing programs and improve the accuracy of its contracted auditors," she added. 

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