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 1-10 of 151 entries
Issue Name Review Type Provider Type MAC Jurisdiction Date Approved
0190-Skilled Nursing Facility with Patient-Driven Payment Model: Medical Necessity and Documentation Requirements Complex SNF All A/B MACs
0056 - Evaluation and Management Services in Skilled Nursing Facilities: Incorrect Coding Automated Professional Services All A/B MACs
0150-Mohs Micrographic Surgery: Incorrect Coding and Incorrect Units Billed Complex Professional Services All A/B MACs
0124-Part B Therapies During Inpatient: Unbundling Automated Professional Services All A/B MACs
0091 - Duplicate Claims- Professional Services Automated Professional Services All A/B MACs
0089 - Clinical Social Worker during Inpatient: Unbundling Automated Professional Services All A/B MACs
0110-Skilled Nursing Facility Consolidated Billing: Part B – Use of Modifier 26, Professional Component Automated Professional Services All A/B MACs
0062 - Radiology: Technical Component during Inpatient Stay Automated Professional Services All A/B MACs
0043 - New Patient Visits: Incorrect Coding Automated Professional Services All A/B MACs
0149-Subsequent Hospital Visit and Discharge Day Management on the Same Day: Unbundling Automated Professional Services All A/B MACs
Page Last Modified:
09/06/2023 05:05 PM
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