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 31-40 of 151 entries
Issue Name Review Type Provider Type MAC Jurisdiction Date Approved
0073 - Inpatient Rehabilitation Facility: Medical Necessity and Documentation Requirements Complex Inpatient Rehabilitation Facility (IRF) All A/B MACs
0108-Facility versus Non-Facility Reimbursement: Incorrect Coding Automated Professional Services All A/B MACs
0138-Skilled Nursing Facility Consolidated Billing for Therapies: Unbundling Automated Professional Services All A/B MACs
0042-Evaluation and Management Services for Office or Other Outpatient Visit Billed for Hospital Inpatients: Incorrect Coding Automated Professional Services All A/B MACs
0148-Same Knee Orthosis within Reasonable Useful Lifetime: Excessive Units Automated DME Physician/ DME Supplier All DME MACs
0104-Add-on Code Paid without Primary Code and/or Denied Primary Code- Ambulatory Surgical Center Automated Ambulatory Surgical Center (ASC) All A/B MACs
0186-Duplex Scans of Extracranial Arteries: Medical Necessity and Documentation Requirements Complex Outpatient Hospital J5, J6, J8, J15, JH, JK, JL, JN (JE, JF, JJ, JM are excluded)
0169-Outpatient Services within 3 Days Prior to and Including the Date of a Hospital Admission: Unbundling Automated Outpatient Hospital All A/B MACs
0215-Canes, Crutches, and Walkers within the Reasonable Useful Lifetime: Excessive Units Automated DME by Supplier; DME by Physician All DME MACs
0038 - Visits to Patients in Swing Beds: Incorrect Coding Automated Professional Services All A/B MACs
Page Last Modified:
09/06/2023 05:05 PM
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