Health Law Alert: Increased RAC Record Request Limits

March 21, 2012

Last week, CMS released new, increased RAC record request limits for hospitals effective March 15, 2012.  Under the new rule, the limit is 2% of all Medicare claims (of all types, including professional services) submitted for the previous calendar year divided by 8, up to a maximum of 400 requests every 45 days.  For small providers who otherwise would have a calculated limit of 34 records or less, Connolly may request up to 35 records every 45 days.  This is an increase from the previous 1% limit.

The limits apply per campus, which is defined as one or more facilities under the same tax identification number located in the same area (using the first three positions of the zip code).  CMS notes that this is a different definition than that used to determine provider-based status.