RAC Auditors Empowered to Perform Complex Reviews

The Centers for Medicare & Medicaid Services has set the number of medical records that the Recovery Audit Contractor (RAC) can request from a medical practice.

This means RACs now can do complex reviews (these are the type that require medical records) on physicians and nonphysician practitioners (NPPs). Auditors were prevented from performing these reviews until the record limits were established.

As explained in Physician ADR Limits fact sheet (PDF), the limits are based on: 

  1. The physician’s or NPPs billing tax identification number (TIN), as well as the first three positions of the ZIP code where that person is physically located, and
  2. The number of individual rendering physicians/NPPs reported under each TIN/ZIP combination in the previous calendar year.

Published April 4, 2011


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