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 160 entries
Issue Number - Name Review Type Provider Type MAC Jurisdiction Date Approved
0001 - Inpatient Hospital MS - DRG Coding Validation Complex Inpatient Hospital All A/B MACs 2017-02-01
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 2017-02-01
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 2017-02-01
0004 - Skilled Nursing Facility: Medical Necessity and Documentation Requirements Complex Skilled Nursing Facility (SNF) All A/B MACs 2017-02-01
0008 - Bariatric Surgery-Medical Necessity and Documentation Requirements Complex Outpatient Hospital All A/B MACs 2017-02-01
0010 - Cardiac Positron Emission Tomography Scans: Medical Necessity and Documentation Requirements Complex Laboratory/Ambulance; Outpatient Hospital; Professional Services JN 2017-02-01
0011 - Inappropriate Billing of Home Visit Professional Service Evaluation and Management Codes during Inpatient Automated Professional Services All A/B MACs 2017-02-01
0012 - Blood Glucose Monitors: Medical Necessity and Documentation Requirements Complex DME Physician/ DME Supplier All DME MACs 2017-05-08
0013 - Ankle-Foot Orthoses and Knee-Ankle-Foot Orthoses: Medical Necessity and Documentation Requirements Complex DME Physician/DME Supplier All DME MACs 2017-07-05
0014 - Automated Glucose Monitor When Billed With Same Date of Services as Glucose Monitor Supplies (Unbundling) Automated DME Physician/DME Supplier All DME MACs 2017-02-01
Page Last Modified:
11/15/2019 03:30 PM