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RAC Record Requests Expanded for Facilities

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  • In Audit
  • April 12, 2012
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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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