Approved RAC Topics

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.

Note: CMS often receives referrals of potential improper payments from the MACs, UPICs, and Federal investigative agencies (e.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.


Showing 1-10 of 157 entries
Issue Name Review Type Provider Type MAC Jurisdiction Date Approved
0001 - Inpatient Hospital MS - DRG Coding Validation Complex Inpatient Hospital All A/B MACs
0002 - Cataract Removal: Medical Necessity and Documentation Requirements Complex Ambulatory Surgical Center (ASC); Outpatient Hospital JE, JF, JH, JJ, JK, JL, JN, J6, J8, J11, J15
0003 - Sacral Neurostimulation: Medical Necessity and Documentation Requirements Complex Ambulatory Surgical Center (ASC); Inpatient Hospital; Outpatient Hospital; Professional Services Urinary incontinence- All A/B MACs Fecal incontinence- JE, JF, JH, JL, JN, J15
0004 - Skilled Nursing Facility: Medical Necessity and Documentation Requirements Complex Skilled Nursing Facility (SNF) All A/B MACs
0008 - Bariatric Surgery-Medical Necessity and Documentation Requirements Complex Inpatient Hospital; Outpatient Hospital All A/B MACs
0010 - Cardiac Positron Emission Tomography Scans: Medical Necessity and Documentation Requirements Complex Laboratory/Ambulance; Outpatient Hospital; Professional Services JN
0011 - Inappropriate Billing of Home Visit Professional Service Evaluation and Management Codes during Inpatient Automated Professional Services All A/B MACs
0012 - Blood Glucose Monitors: Medical Necessity and Documentation Requirements Complex DME Physician/ DME Supplier All DME MACs
0013 - Ankle-Foot Orthoses and Knee-Ankle-Foot Orthoses: Medical Necessity and Documentation Requirements Complex DME Physician/DME Supplier All DME MACs
0014 - Glucose Monitor Supplies When Billed With Same Dates of Service as Glucose Monitor: Unbundling Automated DME Physician/DME Supplier All DME MACs
Page Last Modified:
06/16/2020 06:45 PM