CMS Revises Institutional Provider Recovery Audit Contractor (RAC) Additional Documentation Request



CMS has announced the revision of Recovery Audit Contractor (RAC) ADR limits, effective May 1, 2022. Historically, the baseline annual ADR Limit has been one-half of one percent (0.5%) of the provider’s total number of paid Medicare claims from a previous 12-month period. This statement now excludes Skilled Nursing Facility (SNF), Type of Bills (TOBs) and Inpatient Rehab Facilities (IRF) TOBs.


In response to feedback from RAC Program stakeholders, CMS has modified the institutional ADR limits for SNF and IRF Provider Types for the RAC Program. For these provider types, the baseline annual ADR limit is one percent (1%) of the provider’s total number of paid Medicare claims from a previous 12-month period. The baseline annual ADR limit is divided by eight (8) to establish the ADR cycle limit, which is the maximum number of claims that can be included in a single 45-day period. Risk-Based, Adjusted ADR limits remain in place.


Please find the direct link to the official Medicare FFS Recovery Audit Program announcement at, https://www.cms.gov/files/document/adr-limits-institutional-provider-facilities-may-1-2022.pdf



Let's Get to the Point:

Providers should prepare for an increase in Medical Review activity by the Recovery Audit Contractor. QRM is here to assist; please forward questions/inquiries to QRM’s Medical Review team, medreview@qrmhealth.com