Recovery Audit Contractors Are Different From Other Improper Payment Review Contractors Because
Do you have questions or concerns about the Recovery Audit Programme? Please e-mail usa at RAC@cms.hhs.gov. Delight Do Not transport Personal Health Information to this electronic mail address.
The Medicare Fee for Service (FFS) Recovery Inspect Program'due south mission is to place and correct Medicare improper payments through the efficient detection and collection of overpayments made on claims of wellness intendance services provided to Medicare beneficiaries, and the identification of underpayments to providers then that the CMS can implement actions that will forbid time to come improper payments in all l states.
What does a Recovery Audit Contractor (RAC) practise?
RAC'south review claims on a mail-payment ground. The RAC's notice and correct past improper payments so that CMS and Carriers, FIs, and MACs tin can implement actions that will forestall futurity improper payments.
Who are Recovery Audit Contractors?
| Region | States | Websites | Telephone Number | |
|---|---|---|---|---|
| Region 1 Performant Recovery, Inc. | CT, IN, KY, MA, ME, MI, NH, NY, OH, RI, and VT | https://performantrac.com/ PROVIDERPORTAL.aspx | info@Performantrac.com | 1-866-201-0580 |
| Region 2 Cotiviti, LLC | AR, CO, IA, IL, KS, LA, MO, MN, MS, NE, NM, OK, TX, and WI | https://Cotiviti.com/RAC | RACInfo@Cotiviti.com | 1-866-360-2507 |
| Region 3 Cotiviti LLC | AL, FL, GA, NC, SC, TN, VA, WV, Puerto Rico and U.S. Virgin Islands | https://world wide web.Cotiviti.com/RAC | RACInfo@Cotiviti.com | 1-866-360-2507 |
| Region iv Cotiviti GOV Services (formerly HMS) | AK, AZ, CA, DC, DE, Hi, ID, MD, MT, ND, NJ, NV, OR, PA, SD, UT, WA, WY, Guam, American Samoa and Northern Marianas | https://rac4info.cotiviti.com | rac4info@cotiviti.com | Part A: i-877-350-7992 Function B: 1-877-350-7993 |
| Region 5 DME/HHE/ | Nationwide for DMEPOS/HHA/ Hospice | https://performantrac.com/ PROVIDERPORTAL.aspx | info@Performantrac.com | i-866-201-0580 |
RACs in Regions 1-4 will perform post payment review to identify and correct Medicare claims specific to Function A and Part B.
Region 5 RAC volition exist dedicated to review of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) and Home Health / Hospice
What Topics do RAC'due south Review?
Stay in the know on proposed and approved topics that RAC's are able to review. These topics will be updated monthly on the RAC reviews topic page and include:
- Name of the Review Topic
- Description of what is being reviewed
- States / MAC regions where reviews will occur
- Review Type (circuitous review / automated review)
- Provider Types
- Afflicted Codes
- Applicative Policy References
Recent Updates
March 26, 2021, CMS awarded Performant Recovery, Inc., the incumbent, the new RAC Region 1 contract.
April 24, 2019 - CMS often receives referrals of potential improper payments from the MACs, UPICs, and Federal investigative agencies (eastward.g., OIG, DOJ). At CMS discretion, CMS may require the RAC to review claims, based on these referrals. These CMS-Required RAC reviews are conducted outside of the established ADR limits.
December 21, 2018 - The CMS has posted an updated version of the Institutional-Provider-Facilities-ADR-Limits certificate (/Inquiry-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Recovery-Audit-Plan/Resources). This update changes the ADR "cycle" limit, from nada (0) to 1 (1), for those providers who, under the previous methodology would accept an ADR "bicycle" limit of zero (0), fifty-fifty though their "annual" ADR limit was greater than zero (eastward.g. 1, ii, 3, or iv).
May 17, 2018 - We've updated this Medicare Fee for Service Recovery Audit Program website to include new pages for Canonical and Proposed RAC review topics. These lists will be updated on a monthly footing. All downloadable documents can at present be found on our Resources page.
January 29, 2018 - An updated version of the Institutional Provider (Facilities) ADR Limit document is available in the Downloads surface area of the Provider Resource webpage. The updated version includes boosted information on how Provider Denial Rates are calculated, for Run a risk-Based, Adjusted ADR Limits.
December seven, 2016 - CMS has posted the Fiscal Year 2015 Recovery Audit Programme Report to Congress in the Downloads section of the Recovery Audit Program'south principal page. CMS has besides posted the FY 2015 Recovery Audit Program Appendices, as a companion to the Study.
November 24, 2017 - An updated certificate, listing the Recovery Audit Program Improvement and their respective implementation (effective) dates is now available in the Download area of the Program Reports webpage.
November 9, 2017 - CMS has begun, equally of today, to put a list of review topics that have been proposed, but not yet approved, for RACs to review. These topics will be listed, on a monthly footing, on our Provider Resources folio along with details about the proposed reviews.
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Source: https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Recovery-Audit-Program
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