RAC Relief (Sort Of)


CMS announced that it would reduce the number of additional documentation requests (ADRs) available to its Recovery Audit Contractors (RACs). Effective April 15, 2013, RACs are limited to requesting from providers no more than 75% of the requested claims from one claim type. Previously, there was no such limit. Therefore, if a provider submitted claims for hospital inpatient, hospital outpatient, and physician services, then a RAC may issue ADRs for no more than 75% of one of the claim types (e.g., 75% hospital inpatient and 25% hospital outpatient and physician claims). In addition, CMS reduced the minimum number of medical records that RACs may request from 35 to 20 records. Unfortunately, neither of these changes is available to Medicare suppliers, such as physicians or DME companies. The new guidance is available on the CMS website [PDF].

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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