CMS Updates Additional Document Requests Limits for Medicare Providers

The Centers for Medicare & Medicaid Services (CMS) updated the Medicare provider Additional Documentation Requests (ADR) limitations, which relate to the Medicare Fee-for-Service Recovery Audit Program. These changes went into effect April 15, 2013. The limitations include:

• Recovery Auditors can select up to 75% of any claim type for review (compared to 100%). The remaining 25% can be requested from any or all other types. For example, if a provider submitted three different claim types, the Recovery Auditor may select up to 75% of the calculated ADR from one of the claim types, and the balance of the calculated ADR may be selected from any single or combination of the remaining claim types.
• Recovery Auditors may request up to 20 records per 45 days from providers whose calculated limit is 19 additional documentation requests or less (compared to a minimum of 35 records).

If you have any questions regarding the updated ADR limits, or if you need assistance in preparing for, or defending against RAC audits, or implementing a compliance program geared toward identifying and correcting potential risk areas related to RAC audits, please contact an experienced health care attorney at Wachler & Associates attorney at 248-544-0888