Medicare revises limits for recovery audit program

As of April 15, new limits apply to additional document requests (ADRs) for Medicare providers, with the exceptions of physicians and suppliers.

Recovery Audit Contractors (RACs) can now request as few as 20 medical records per 45-day period; the previous minimum was 35 medical records. Recovery auditors may request up to 20 records per 45 days from providers whose calculated limit is 19 additional documentation requests or fewer. Medical record request limits are calculated by taking 2% of all claims submitted during the previous calendar year and dividing by eight. The maximum amount of RAC medical record requests remains at 400 per 45-day period.

More information is available from CMS.