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Parts C and D Recovery Audit Program

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About the Program

The Medicare Parts C and D Recovery Audit Program was created to identify and correct past improper payments to Medicare providers and implement procedures to help the Centers for Medicare & Medicaid Services (CMS), Medicare carriers, fiscal intermediaries and Medicare Administrative Contractors (MACs) implement actions that will prevent future improper payments. Communication about audit results and trends leads to continuous process improvement and more accurate payments, and helps plan sponsors correct issues in a timely manner.

The Impact. By managing the Part D RAC program CMS/CPI is: Reducing the number of non-compliant claims submitted by Part D sponsors andincreasing the level of protection for Medicare beneficiaries and American taxpayers.

Who We Are

The Center for Program Integrity (CPI) serves as CMS' focal point for all national and statewide Medicare and Medicaid programs and Children's Health Insurance Program (CHIP) integrity fraud and abuse issues. Identifying and preventing improper payments in Medicare Parts C and D is central to that work. CMS/CPI manages the Medicare Part D Recovery Audit Program as a component of that goal.

Spotlight: Audits, Appeals, Resources

Understand the Audit Process

Learn How to Appeal

 

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The initial audit process involves three phases conducted by the Medicare Part D RAC and DVC.

Learn about the audit process here.

There are three levels of the appeals process. Learn about the process and what is required to appeal.

Learn about the appeal process here.

 

Find all of the resources you need including definitions, templates, FAQs, Fact Sheets, HPMS Memos and more.

See all Resources.

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