The new guidelines, which exclude physicians and suppliers, go into effect April 15. According to the CMS guidance, RACs may request a minimum of 20 records in a 45-day period from hospitals, down from the previous minimum of 35 records.
The maximum number of record requests per 45 days is still 400, while hospitals with more than $100 million in MS-DRG payments still have a cap of 600.
CMS also changed limitations on the type of claims RACs can review. Previously, 100 percent of a RAC’s record request could be used toward a single type of claim, such as inpatient or outpatient. Now, RACs can only select up to 75 percent of any claim type for review, while the remaining 25 percent would have to be for other types of claims.
To read the entire update from the CMS regarding RAC documentation limit changes, click here.
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