CMS allows RACs to increase medical record requests

AHA News Now

The Centers for Medicare & Medicaid Services yesterday significantly increased the number of medical records that Recovery Audit Contractors may request from hospitals and other institutional providers. The new annual limit for most providers is 2% of all claims submitted in the prior calendar year, divided by 8. That's up from 1% previously. RACs also may not request more than 400 medical records in a 45-day period, up from 300 previously. Last fall, CMS increased the 45-day cap to 500 for some hospitals with more than $100 million in Medicare Severity-Diagnosis Related Group payments; these hospitals will now have a cap of 600. When responding to a RAC request for medical records, skilled nursing facilities must provide documentation for all claims associated with the full SNF episode of care, from admission to discharge. CMS retains the right to allow RACs to exceed the stated limits. Elizabeth Baskett, AHA senior associate director of policy, commented, "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. 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." For more on the new annual limits, see the CMS notice.

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