What are the medical record request limits for my facility?
Medical records request limits vary by both the size of medical practice or facility and also by the percentage of average monthly Medicare claims for the practice or facility. For individual practitioners, the limit is set at 10 medical records per 45 day period. For a partnership of two to five individuals, the limit is 20 medical records per 45 day period. For groups of six to 15 individuals, the limit is set at 30 medical records per 45 day period. Large groups consisting of 16+ individuals the limit will be 50 medical records per 45 day period. For Inpatient Hospital, IRF, SNF, Hospice by NPI, the percentage of monthly Medicare claims are factored in. 10% of average monthly Medicare paid claims per 45 days Maximum of 200 medical records per 45 days Example 1: Local Community Hospital 1,200 Medicare paid claims in 2008 Divided by 12 = average 100 Medicare paid claims per month x 10% = 10 Limit = 10 medical records per 45 days Example 2: Major Medical Center 12,000 Medicare paid cla
Limits are based on the servicing provider/suppliers Tax Identification Number (TIN) and the first three positions of the ZIP code where they are physically located. Using TINs will reduce the total number of limits that would have been imposed per organization under the previous draft policy, which was based on National Provider Identifiers. Factoring in ZIP codes will promote equitability for regional or national organizations.
