RAC Record Requests Expanded for Facilities

On March 15, recovery audit contractors (RACs) began requesting additional records from hospitals and skilled nursing facilities (SNFs). The new limit requested every 45 days is 2 percent of all claims submitted in the prior year, divided by 8, and subject to specific caps.

Under the new rule, RACs can request up to 400 medical records from a single provider during a 45-day period. That’s up by 25 percent. Before you run around the office unlocking cabinets, however, here are some of the rules:

• The maximum amount is by campus, and a “campus” is all locations under a particular tax identification number.
• Each limit is based on the facility’s prior calender year’s Medicare claims volume.
• Fiscal year limits are based on all submitted claims, paid or denied.
• The maximum number of requests per 45 days is 400 UNLESS your facility has received more than $100,000,000 in Medicare Severity Diagnosis-related Group (MS-DRG) payments whose cap was 500 records; the cap is now 600 records.
• For SNF claims, one additional documentation request represents the beneficiary’s entire episode of care.

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