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 151 entries
Issue Name Review Type Provider Type MAC Jurisdiction Date Approved
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
0065 - Continuous Positive Airway Pressure Machine without an Obstructive Sleep Apnea Diagnosis Automated DME Physician/ DME Supplier All DME MACs
0115-Physician Claims with Place of Service Home Overlapping Inpatient Hospital Stay: Services Billed Not Rendered Automated Professional Services 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
0085 - Laboratory Services Rendered During an Inpatient Stay: Unbundling Automated Laboratory/Ambulance; Outpatient Hospital 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
0164-Bilateral Indicator '3': Incorrect Coding Automated Professional Services All A/B MACs
0126-Endoscopy Procedures: Diagnostic and Surgical Billed Same Day Automated Ambulatory Surgical Center (ASC); Outpatient Hospital; Professional Services All A/B MACs
0072 - Outpatient Service Overlapping or During an Inpatient Stay: Duplicate Payments Automated Outpatient Hospital All A/B MACs
Page Last Modified:
09/06/2023 05:05 PM
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