On April 3, 2013, CMS issued revised provider and supplier additional documentation request (ADR) limitations for the Recovery Audit Contractor (RAC) program. The revised provider ADR limitations are effective April 15, 2013. The revised supplier ADR limitations were effective April 4, 2013.

Revised Provider ADR Limitations

Notably, the revised provider ADR limitations include a 75 percent cap on any particular claim type (the remaining 25 percent can be requested from any or all remaining claim types). Put differently, RACs will only be authorized to select a maximum of 75 percent of any one claim type of the campus ADR limit. The maximum number of ADRs per 45 days remains 400. Providers, however, with over $100,000,000 in MS-DRG payments will have a cap of 600. However, the minimum number of ADRs has been reduced from 34 to 20 for providers whose calculated limit is 19 ADRs or less.

To access the revised provider ADR limitations, click here.

Revised Supplier ADR Limitations

For Suppliers, ADR limits are 10 percent of all claims submitted. The cap for FY 2013 will be 250 ADRs per 45 days. In addition, providers billing with specialty codes 52, 53, 56, or 57 will have an ADR limit not to exceed 10 requests every 45 days. According to the revised supplier ADR limitations, this “limit will only be for orthotic and prosthetic items or services on the claim [and] [t]he standard DME limits for these providers will apply for any other items or services.”

RACs have the ability to request permission from CMS to exceed the established ADR caps.

To access to the revised supplier ADR limitations, click here.