CMS announces RAC program improvements

Effective Jan. 1, the Centers for Medicare & Medicaid Services will reduce the number of claims that Recovery Audit Contractors may audit for health care providers other than physicians and suppliers, the agency announced Friday. The so-called additional documentation request limit will fall from 2% to 0.5% of the provider’s total number of paid Medicare claims from the previous year. RACs will be required to diversify their audits across all claim types for a facility, limiting their ability to target care provided in a particular setting. In addition, CMS will adjust the ADR limit up or down based on the provider’s claim denial rate. Among other recently implemented changes, CMS said it now limits the RAC look-back period to six months from the date of service for patient status reviews in cases where the hospital submits a claim within three months of the date of service.