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 41-50 of 151 entries
Issue Name Review Type Provider Type MAC Jurisdiction Date Approved
0072 - Outpatient Service Overlapping or During an Inpatient Stay: Duplicate Payments Automated Outpatient Hospital All A/B MACs
0073 - Inpatient Rehabilitation Facility: Medical Necessity and Documentation Requirements Complex Inpatient Rehabilitation Facility (IRF) All A/B MACs
0074 - Drugs and Biologicals in Single-Dose Vials: Incorrect Units Billed Complex Outpatient Hospital; Professional Services All A/B MACs
0075 - Home Health: Medical Necessity and Documentation Requirements Complex Home Health Agency (HHA) All HHH MACs
0077 - Annual Wellness Visit Billed Sooner than Eleven Whole Months Following the Initial Preventative Physical Examination Automated Professional Services All A/B MACs
0079 - Ventilators: Medical Necessity and Documentation Requirements Complex DME Physician/ DME Supplier All DME MACs
0080 - Group 2 Support Surfaces: Medical Necessity and Documentation Requirements Complex DME Physician/ DME Supplier All DME MACs
0081 - Negative Pressure Wound Therapy: Medical Necessity and Documentation Requirements Complex 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
0086 - Observation Evaluation & Management (E&M) Services Billed Same Day as Inpatient Admission: Unbundling Automated Professional Services All A/B MACs
Page Last Modified:
09/06/2023 05:05 PM
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