Approved RAC Topics

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 21-30 of 151 entries
Issue Name Review Type Provider Type MAC Jurisdiction Date Approved
0142-Ambulatory Surgical Center Services Billed During a Covered Part A Skilled Nursing Facility Stay: Unbundling Automated Ambulatory Surgical Center (ASC); Skilled Nursing Facility (SNF) All A/B MACs
0060 - Untimed Therapy: Excessive Units Automated Comprehensive Outpatient Rehabilitation Facility (CORF); Outpatient Hospital; Outpatient Rehabilitation Facility (ORF); Professional Services; Skilled Nursing Facility All A/B MACs
0215-Canes, Crutches, and Walkers within the Reasonable Useful Lifetime: Excessive Units Automated DME by Supplier; DME by Physician All DME MACs
0114-Durable Medical Equipment Billed during Hospice Period: Unbundling Automated DME Physician, DME Supplier All DME MACs
0046 - Durable Medical Equipment Rentals- Multiple Billing within the Same Month Automated DME Physician/ DME Supplier All DME MACs
0107-Custom Fabricated Knee Orthoses: Medical Necessity and Documentation Requirements Complex DME Physician/ DME Supplier All DME MACs
0065 - Continuous Positive Airway Pressure Machine without an Obstructive Sleep Apnea Diagnosis Automated DME Physician/ DME Supplier All DME MACs
0069 - Respiratory Assist Devices: Medical Necessity and Documentation Requirements Complex DME Physician/ DME Supplier All DME MACs
0144-Prefabricated Knee Orthoses: Medical Necessity and Documentation Requirements Complex DME Physician/ DME Supplier All DME MACs
0173-Surgical Dressings: Medical Necessity and Documentation Requirements Complex DME Physician/ DME Supplier All DME MACs
Page Last Modified:
09/06/2023 05:05 PM
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