CMS Changes Documentation Request Burden on Healthcare Providers

  • Email
  • Print
  • Printing Articles

    1. Click here to print!
    2. ...or print directly from your browser by choosing File > Print... from the menu or by pressing [Ctrl + P]. Our printer-friendly stylesheet will make sure extraneous website stuff isn't printed.
    3. You're done!

    Close this message.

  • Comments
  • RSS

The Centers for Medicare and Medicaid Services (CMS) announced two changes to regulations covering the additional documentation request (ADR) process for Medicare providers (except suppliers and physicians) under the CMS Recovery Audit Program.

Beginning April 15, CMS Recovery Audit Contractors (RACs) may request up to 20 records per 45 days from providers whose calculated limit is 19 additional documentation requests or less. Currently contractors may request up to 35 records.

Also, RACs will still be allowed to request additional documentation on up to 2 percent of claims, but of that 2 percent only three-quarters can come from any particular claim type, among them:

  • Acute hospital inpatient (IPPS) claims
  • Hospital outpatient (OPPS) claims
  • Skilled nursing facility (SNF) claims
  • Inpatient rehabilitation facility (IRF) claims
  • Inpatient psychiatric facility (IPF) claims
  • Ambulatory surgery center (ASC) claims
  • Physician claims

The current regulations allows RAC auditors to make 100 percent of its ADR from any one claim type.

The number of ADRs is based on a provider’s Medicare claim volume from the previous year. The 2012 numbers that set the ADR levels beginning April 15 will be released on that date.

The chart below lists what processes have changed and what will change on April 15:

Screen Shot 2013-04-09 at 9.51.39 AM

 

 

  • Email
  • Print
  • Printing Articles

    1. Click here to print!
    2. ...or print directly from your browser by choosing File > Print... from the menu or by pressing [Ctrl + P]. Our printer-friendly stylesheet will make sure extraneous website stuff isn't printed.
    3. You're done!

    Close this message.

  • Comments
  • RSS

Posted in Denials Management, Medical Receivables, Patient Experience, Patient Financial Services .

×
Subscribe to our email newsletters

Continuing the Discussion

We welcome and encourage readers to comment and engage in substantive exchanges over topics on insideARM.com. Users must always follow our Terms of Use. Also know that your comment will be deleted if you: use profanity, engage in any kind of hate speech, post an incoherent or irrelevant thought, make a point of targeting anyone, or do anything else we find unsavory. Your comment will be posted under your current Display Name, shown below. If you'd like to change your Display Name, you must update it on the My Profile page.

Leave a Reply