In August, CMS said Medicare RACs could request up to no more than 1 percent of all claims for providers, also divided by eight. A provider’s limit will be applied across all claim types, including professional services.
For example, if a hospital billed 156,253 claims last year, 2 percent of those claims equals 3,125. The limit is then found by dividing that number by eight, meaning RACs can request up to no more than 390 requests every 45 days, double the previous amount.
However, CMS may also give RACs permission to exceed the limit if CMS believes it is necessary or if the RAC requests permission. CMS or the RAC would notify the hospital in writing in those situations.
More Articles on Medicare RACs:
AHA: More Than 70% of Hospitals Successfully Appeal RAC Denials
How to Bill for Renal and Urinary Tract Disorders and Avoid RACs
Medicare RACs Collected $1.27B in Overpayments Since 2009
At the Becker's 11th Annual IT + Revenue Cycle Conference: The Future of AI & Digital Health, taking place September 14–17 in Chicago, healthcare executives and digital leaders from across the country will come together to explore how AI, interoperability, cybersecurity, and revenue cycle innovation are transforming care delivery, strengthening financial performance, and driving the next era of digital health. Apply for complimentary registration now.
