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 11-20 of 151 entries
Issue Name Review Type Provider Type MAC Jurisdiction Date Approved
0176-Annual Wellness Visit: Incorrect Coding Complex Professional Services All A/B MACs
0129-Hyperbaric Oxygen Therapy for Diabetic Wounds: Medical Necessity and Documentation Requirements Complex Outpatient Hospital 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
0037 - Hospital Services: Excessive Units Automated Professional Services All A/B MACs
0160-Intravenous Immune Globulin for the Treatment of Autoimmune Blistering Diseases: Medical Necessity and Documentation Requirements Complex Ambulatory Surgical Center (ASC); Outpatient Hospital; Professional Services All A/B MACs
0183-Specialty Care Transport: Medical Necessity and Documentation Requirements Complex Ambulance All A/B MACs
0136-Radiologic Examination of the Chest: Medical Necessity and Documentation Requirements Complex Outpatient Hospital All A/B MACs
0202- Skilled Nursing Facility (SNF) Consolidated Billing for Ambulance Transports: Unbundling Automated Ambulance All A/B MACs
0077 - Annual Wellness Visit Billed Sooner than Eleven Whole Months Following the Initial Preventative Physical Examination Automated Professional Services All A/B MACs
0022 - Inpatient Psychiatric Admission Billed without Source of Admission Equal to "D" Automated Inpatient Hospital; Inpatient Psychiatric Facility (IPF) All A/B MACs
Page Last Modified:
09/06/2023 05:05 PM
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