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 11-20 of 151 entries
Issue Name Review Type Provider Type MAC Jurisdiction Date Approved
0221- Hospice Care- Extended Length of Stay: Medical Necessity and Documentation Requirements Complex Hospice HH/Hospice MACs
0174-Cervical Orthoses within the Reasonable Useful Lifetime: Excessive Units Automated DME Physician/ DME Supplier DME MACs
0201-Hospice Continuous Home Care: Medical Necessity and Documentation Requirements Complex Hospice All HHH MACs
0075 - Home Health: Medical Necessity and Documentation Requirements Complex Home Health Agency (HHA) All HHH MACs
0018 - Spring-Powered Devices: Excessive Units Automated DME Physician/ DME Supplier All DME MACs
0103-Urological Supplies: Medical Necessity and Documentation Requirements Complex DME Physician/DME Supplier All DME MACs
0019 - Durable Medical Equipment Billed while Inpatient: Unbundling Automated DME Physician/DME Supplier All DME MACs
0114-Durable Medical Equipment Billed during Hospice Period: Unbundling Automated 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
0014 - Glucose Monitor Supplies When Billed With Same Dates of Service as Glucose Monitor: Unbundling Automated DME Physician/DME Supplier All DME MACs
Page Last Modified:
09/06/2023 05:05 PM
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