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 21-30 of 151 entries
Issue Name Review Type Sort descending Provider Type MAC Jurisdiction Date Approved
0124-Part B Therapies During Inpatient: Unbundling Automated Professional Services All A/B MACs
0174-Cervical Orthoses within the Reasonable Useful Lifetime: Excessive Units Automated DME Physician/ DME Supplier DME MACs
0091 - Duplicate Claims- Professional Services Automated Professional Services All A/B MACs
0089 - Clinical Social Worker during Inpatient: Unbundling Automated Professional Services All A/B MACs
0047 - Panretinal (Scatter ) Laser Photocoagulation: Excessive Frequency Automated Outpatient Hospital; Professional Services J6, JK, J15
0147-Magnetic Resonance Imaging Procedures: Excessive Units Automated Outpatient Hospital; Professional Services All A/B MACs
0051 - Global versus Technical Component/Professional Component Reimbursements: Unbundling Automated Laboratory/Ambulance; Professional Services All A/B MACs
0099-Skilled Nursing Facility Consolidated Billing: Unbundling Automated Outpatient Hospital All A/B MACs
0062 - Radiology: Technical Component during Inpatient Stay Automated Professional Services All A/B MACs
0043 - New Patient Visits: Incorrect Coding Automated Professional Services All A/B MACs
Page Last Modified:
09/06/2023 05:05 PM