RAC Audits Will Now Account for Product Volume

Requests for additional documentation will be based on the number of claims a provider has in a category.

CMS has released new guidance for the Recovery Audit Contractor (RAC), which will limit additional documentation requests (ADRs) so that they are based on the number of claims for a product category.

“Currently, the RAC’s methodology is based on a total claim number by NPI without consideration for the number of claims in a particular product category,” a statement from the American Association for Homecare read. “This means that suppliers can receive large volumes of RAC audits for a product category in which they do minimal business.”

Under the new guidance, the RAC will account for the volume of claims by product category, which should improve its program integrity efforts. 

“Limits will be set at 10% of all paid claims, by policy group, paid within a previous 12-month period, divided into eight periods (45 days). Although a RAC may go more than 45 days between record requests, in no case shall a RAC make requests more frequently than every 45 days,” according to CMS’s guidance.

CMS’s complete ADR guidance can be downloaded as a PDF

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