CMS reveals RAC program improvements: 4 things to know

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CMS will reduce the number of claims that Recovery Audit Contractors may audit for healthcare providers other than physicians and suppliers, effective Jan. 1.

Here are four changes to the RAC program CMS recently announced.

1. The annual additional documentation request limit will be 0.5 percent of the provider's total number of paid Medicare claims from the previous year. That is a decrease from the current limit of 2 percent.

2. The additional documentation requests will be diversified across all claim types for a facility. This limits RACs' ability to target care provided in a particular setting. Earlier this year, CMS said providers were concerned the recovery auditors were focusing much of their resources on inpatient hospital claims.

3. CMS said it will adjust a provider's additional documentation request limit down if the provider has a low claim denial rate, while it will adjust the limit up for those with high denial rates. This change was made based on industry feedback that the additional documentation limits are the same for all providers of similar size and are not adjusted based on a provider's compliance with Medicare rules.

4. Among other recently implemented changes, CMS said it now limits the RAC look-back period for patient status reviews to six months after the date of services if the hospital has submitted its claims within three months of the date of service.

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