Eli's Hospice Insider

Published on Sun Nov 21, 2010 PDF

You're following the rules -- and the RACs should, too.

Your organization isn't the only party in the RAC-provider relationship that has to play by the rules. The RACs are required to stay within the following guidelines when requesting documentation from medical providers, according to the MLN Matters article.

The RAC must:

• indicate the deadline by which you have to submit your medical records.
• contact you one additional time before denying your service based on lack of documentation.
• accept and review extension requests if you can't submit your documentation in a timely manner.
• suggest which types of documentation will help its employees adjudicate the claim.
• accept medical records on CDs, DVDs, or via fax.
• limit its claims look-back period to three years, with a maximum look-back date of Oct. 1, 2007.
• limit the number of medical requests every 45 days.
• indicate the status of the provider's additional documentation request on its claim status website.
• maintain a provider web portal where providers can customize their address and find the correct point of contact.
• post all approved issues under review on its website.