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Medicare Fee for Service Recovery Audit Program

Do you have questions or concerns about the Recovery Audit Program? Please e-mail us at RAC@cms.hhs.gov. Please Do Not send Personal Health Information to this e-mail address.

The Medicare Fee for Service (FFS) Recovery Audit Program’s mission is to identify and correct Medicare improper payments through the efficient detection and collection of overpayments made on claims of health care services provided to Medicare beneficiaries, and the identification of underpayments to providers so that the CMS can implement actions that will prevent future improper payments in all 50 states.

What does a Recovery Audit Contractor (RAC) do?

RAC's review claims on a post-payment basis. The RAC's detect and correct past improper payments so that CMS and Carriers, FIs, and MACs  can implement actions that will prevent future improper payments.

Who are Recovery Audit Contractors?

Recovery Audit Contractors
Region States Websites Email Phone 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://www.Cotiviti.com/RAC RACInfo@Cotiviti.com 1-866-360-2507

Region 4

HMS Federal Solutions

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://racinfo.hms.com/home.aspx racinfo@emailhdi.com

Part A: 1-866-590-5598 

Part B: 1-866-376-2319

Region 5

DME/HHE/Performant Recovery, Inc.

Nationwide for DMEPOS/HHA/Hospice

https://performantrac.com/

PROVIDERPORTAL.aspx

info@Performantrac.com 1-866-201-0580

RAC Region Map

RACs in Regions 1-4 will perform post payment review to identify and correct Medicare claims specific to Part A and Part B.

Region 5 RAC will be dedicated to review of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) and Home Health / Hospice

What Topics do RAC's 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 (complex review / automated review)
  • Provider Types
  • Affected Codes
  • Applicable Policy References

Recent Updates

May 17, 2018 - We’ve updated this Medicare Fee for Service Recovery Audit Program website to include new pages for Approved and Proposed RAC review topics. These lists will be updated on a monthly basis. All downloadable documents can now 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 area of the Provider Resource webpage. The updated version includes additional information on how Provider Denial Rates are calculated, for Risk-Based, Adjusted ADR Limits.

December 7, 2016 - CMS has posted the Fiscal Year 2015 Recovery Audit Program Report to Congress in the Downloads section of the Recovery Audit Program's main page. CMS has also posted the FY 2015 Recovery Audit Program Appendices, as a companion to the Report.

November 24, 2017 - An updated document, 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, as 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 basis, on our Provider Resources page along with details about the proposed reviews.

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