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CMS lowers RAC minimum record request limit for hospitals, other providers

April 5, 2013

The Centers for Medicare & Medicaid Services has reduced the minimum number of medical records that Recovery Audit Contractors may request from Medicare providers other than physicians and suppliers. Effective April 15, RACs may issue a minimum request of 20 records in a 45-day period from hospital and other provider campuses, down from a previous minimum of 35 records. In addition, only 75% of a hospital’s record request limit may be used for a particular type of claim, such as inpatient, down from 100% previously. The AHA-supported Medicare Audit Improvement Act (H.R. 1250), introduced March 19, would limit RAC medical record requests by campus to 2% of the Medicare claims submitted for a particular care setting, such as inpatient, outpatient, skilled nursing facility or inpatient rehabilitation.