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CMS discusses limits on medical record requests by RACs

CMS discusses limits on medical record requests by RACs
October 21, 2008

During an AHA member call today to discuss the nationwide rollout of the permanent Medicare recovery audit contractor program, Centers for Medicare & Medicaid Services staff announced limits on the number of medical records the RACs will be allowed to request from providers. For inpatient claims, the maximum number of records RACs may request will vary by the hospital’s national provider identifier and will equal 10% of average monthly Medicare claims. The RACs will not be able to request more than 200 records in a 45-day period for both inpatient and outpatient claims combined. Providers with more than one NPI may face a unique record limit per NPI; however, CMS staff said they plan to provide further clarification on this policy. Earlier this month, CMS announced the names of the permanent RACs and revised plans for the nationwide rollout. Hospitals in the first phase of the rollout may begin to receive requests for medical records or reimbursement of overpayments as early as December. For more on the RAC program, visit www.aha.org/rac.