Medical record cap raised under new RAC regulation


The Centers for Medicare & Medicaid Services significantly increased the number of medical records that can be requested by Recovery Audit Contractors from hospitals and other institutional providers.

Under the new regulation, announced by CMS on March 16, the annual limit for most providers is 2 percent of all claims submitted in the prior calendar year, divided by 8. That’s up from 1 percent previously. RACs also may not request more than 400 medical records in a 45-day period, up from 300 previously.

The American Hospital Association (AHA) voiced concerns about the regulation.

“Hospitals strive for payment accuracy and are committed to working with CMS to ensure the accuracy of Medicare and Medicaid payments,” said Elizabeth Baskett senior director of the AHA in a prepared statement. “However, the flood of new auditing programs has saddled hospitals with duplicative audits, unmanageable medical record requests and inappropriate payment denials. The AHA opposes the dramatic increases in medical record request limits for the RAC program and will continue to press CMS to streamline its redundant payment auditing programs and improve the accuracy of its contracted auditors.”

Last fall for some hospitals with more than $100 million in Medicare Severity-Diagnosis Related Group payments, CMS increased the 45-day cap to 500 records. Under the new regulation, these hospitals will now have a cap of 600.

When responding to a RAC request for medical records, skilled nursing facilities must provide documentation for all claims associated with the full SNF episode of care, from admission to discharge. CMS retains the right to allow RACs to exceed the stated limits.

The complete CMS notice can be found here.

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