tci Medicare Compliance & Reimbursement - 2016 Issue 1

Industry Note: RACs Could Face Limits Very Soon

CMS is reining in its Recovery Audit Contractors (RACs) somewhat, but it may not stay that way. Starting in January, CMS is establishing Additional Development Request limits for RACs based on a provider’s compliance with Medicare rules, CMS notes on its RAC web page. “Providers with low denial rates will have lower ADR limits while providers with high denial rates will have higher ADR limits,” CMS says. “The ADR limits will be adjusted as a provider’s denial rate decreases, resulting in the provider that complies with Medicare rules having less Recovery Auditor reviews.&rdquo...

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