BALTIMORE — In response to feedback, CMS said it has
modified the additional documentation request limits for the
Recovery Audit Contractor program in FY2011. The agency said it
will set the limits on a regular basis to establish a cap per
supplier on the maximum number of medical records that a RAC can
request per 45-day period. Limits will be set at 10 percent of all
claims submitted for the previous full calendar year, divided into
eight periods (45 days). The agency gave these examples:
Supplier A billed 1,253 claims last year. The supplier's
additional documentation limit would be (1,253 * 0.1) / 8 =
15.6625, or 16 additional documentation requests per 45 days.
Supplier B billed 255,000 claims last year. The supplier's
additional documentation limit would be (255,000 * 0.1) / 8 =
3,187.5. The provider's additional documentation limit would be
3,188 additional documentation requests every 45 days, if there
were no cap in place.
The cap for FY2011 will be 250 additional documentation requests
per 45 days for all suppliers. (The government's 2011 fiscal year
runs from Oct. 1, 2010, through Sept. 30, 2011.) The RACs will be
allowed to request permission to exceed the cap, but they must
request approval from CMS on a case-by-case basis. For questions,
contact RAC@cms.hhs.gov.
