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
Becker’s 3rd Annual Fall Chief Pharmacy Officer Summit is the top tier event that the people leading the future of pharmacy convene. This 3-day event is built specifically for Chief Pharmacy Officers and senior pharmacy leaders. The sessions examine the workforce, financial and clinical priorities shaping pharmacy today. Becker’s is where candid discussions flourish and new ideas thrive. Becker's 3rd Annual Fall Chief Pharmacy Officer Summit
