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 153 entries
Issue Name Review Type Provider Type MAC Jurisdiction Date Approved
0218-Medical Supplies Billed from Consolidated Billing List During a Home Health Episode: Unbundling Automated DME Physician/ DME Supplier All DME MACs
0064 - Facility Duplicate Claims Automated Inpatient Hospital; Outpatient Hospital; Skilled Nursing Facility (SNF) 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
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
0085 - Laboratory Services Rendered During an Inpatient Stay: Unbundling Automated Laboratory/Ambulance; Outpatient Hospital All A/B MACs
0047 - Panretinal (Scatter ) Laser Photocoagulation: Excessive Frequency Automated Outpatient Hospital; Professional Services J6, JK, J15
0028 - Annual Wellness Visit: Excessive Units Automated Professional Services All A/B MACs
0182-Reduction of Technical Component, Diagnostic Cardiovascular Services Automated Professional Services All A/B MACs
0124-Part B Therapies During Inpatient: Unbundling Automated Professional Services All A/B MACs
Page Last Modified:
09/06/2023 05:05 PM
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