CMS Sets RAC Request Limits for FY2011

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 [email protected].