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 Sort descending 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
0114-Durable Medical Equipment Billed during Hospice Period: Unbundling Automated DME Physician, DME Supplier All DME MACs
0019 - Durable Medical Equipment Billed while Inpatient: Unbundling Automated DME Physician/DME Supplier All DME MACs
0124-Part B Therapies During Inpatient: Unbundling Automated Professional Services All A/B MACs
0174-Cervical Orthoses within the Reasonable Useful Lifetime: Excessive Units Automated DME Physician/ DME Supplier DME 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
0047 - Panretinal (Scatter ) Laser Photocoagulation: Excessive Frequency Automated Outpatient Hospital; Professional Services J6, JK, J15
0051 - Global versus Technical Component/Professional Component Reimbursements: Unbundling Automated Laboratory/Ambulance; Professional Services All A/B MACs
0099-Skilled Nursing Facility Consolidated Billing: Unbundling Automated Outpatient Hospital All A/B MACs
Page Last Modified:
09/06/2023 05:05 PM