CMS announced that starting March 15, 2012, Medicare Recovery Auditors may request up to 2 percent of all claims submitted for the previous calendar year divided by eight — an increase from the previous 1 percent limit.
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.
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.
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