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 141-150 of 151 entries
Issue Name Review Type Provider Type MAC Jurisdiction Date Approved
0077 - Annual Wellness Visit Billed Sooner than Eleven Whole Months Following the Initial Preventative Physical Examination Automated Professional Services All A/B MACs
0183-Specialty Care Transport: Medical Necessity and Documentation Requirements Complex Ambulance All A/B MACs
0182-Reduction of Technical Component, Diagnostic Cardiovascular Services Automated Professional Services All A/B MACs
0037 - Hospital Services: Excessive Units Automated Professional Services All A/B MACs
0094 - Group 3 Pressure-Reducing Support Surfaces: Medical Necessity and Documentation Requirements Complex DME Physician/DME Supplier All DME MACs
0129-Hyperbaric Oxygen Therapy for Diabetic Wounds: Medical Necessity and Documentation Requirements Complex Outpatient Hospital All A/B MACs
0177-Hospital Beds: Medical Necessity and Documentation Requirements Complex DME Physician/DME Supplier All DME 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
0209-Parenteral Nutrition Therapy with Dates of Service on/after September 5, 2021: Medical Necessity and Documentation Requirements Complex 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
Page Last Modified:
09/06/2023 05:05 PM
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