Medicare Fee for Service Recovery Audit Program

Medicare Fee for Service Recovery Audit Program

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.

The Medicare Fee for Service (FFS) Recovery Audit Program’s mission is to identify and correct Medicare improper payments through the efficient detection and collection of overpayments made on claims of health care services provided to Medicare beneficiaries, and the identification of underpayments to providers so that the CMS can implement actions that will prevent future improper payments in all 50 states.

What does a Recovery Audit Contractor (RAC) do?

The RACs conduct both complex and automated post-payment reviews. Automated reviews occur at the system level while complex reviews require a qualified individual to review the medical record. In order to obtain the medical record and any supporting documentation, the RAC shall issue an Additional Documentation Request (ADR). For more information regarding ADRs, please visit: https://www.cms.gov/research-statistics-data-systems/medicare-fee-service-compliance-programs/medical-review-and-education/additional-documentation-request

Who are Recovery Audit Contractors?

Recovery Audit Contractors
RegionStatesWebsitesEmailPhone Number

Region 1

Performant Recovery, Inc.

CT, IN, KY, MA, ME, MI, NH, NY, OH, RI, and VT

https://performantrac.com/

PROVIDERPORTAL.aspx

info@Performantrac.com1-866-201-0580

Region 2

Performant Recovery, Inc.

NOTE: Please see March 28, 2023 update below

AR, CO, IA, IL, KS, LA, MO, MN, MS, NE, NM, OK, TX, and WI

https://performantrac.com/

PROVIDERPORTAL.aspx

info@Performantrac.com

 

 

1-866-201-0580

 

 

Region 3

Cotiviti LLC

AL, FL, GA, NC, SC, TN, VA, WV, Puerto Rico and U.S. Virgin Islands

https://www.Cotiviti.com/RAC

 

racinfo@cotiviti.com1-866-360-2507

Region 4

Cotiviti GOV Services

(formerly HMS)

AK, AZ, CA, DC, DE, HI, ID, MD, MT, ND, NJ, NV, OR, PA, SD, UT, WA, WY, Guam, American Samoa and Northern Marianashttps://rac4info.cotiviti.com

rac4info@cotiviti.com

Part A: 1-877-350-7992

Part B: 1-877-350-7993

Region 5

DME/HHE/Performant Recovery, Inc.

Nationwide for DMEPOS/HHA/Hospice

https://performantrac.com/

PROVIDERPORTAL.aspx

info@Performantrac.com1-866-201-0580


Map of RAC regions (2023)

 

 

 

 

 

 

 

 

 

 

 

RACs in Regions 1-4 will perform post payment review to identify and correct Medicare claims specific to Part A and Part B.

Region 5 RAC will be dedicated to review of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) and Home Health / Hospice

What Topics do RACs Review?

Stay in the know on proposed and approved topics that RACs are able to review. These topics will be updated monthly on the RAC reviews topic page and include:

  • Name of the Review Topic
  • Description of what is being reviewed
  • States / MAC regions where reviews will occur
  • Review Type (complex review / automated review)
  • Provider Types
  • Affected Codes
  • Applicable Policy References

Recent Updates

March 28, 2023 - On March 24, 2022, CMS awarded Performant Recovery, Inc., the new Recovery Audit Contractor (RAC) Region 2 contract.  RAC Region 2 includes the following Medicare Administrative Contractor (MAC) jurisdictions: J5, J6, and JH.

Cotiviti, LLC, the RAC previously responsible for reviews in Region 2, remains under contract with CMS to support the RAC Program from an administrative and appeals perspective in this region. Please contact Cotiviti in regards to reviews conducted by Cotiviti. All notification of improper payments, including review results letters (complex reviews), informational letters (automated reviews) and no findings letters (complex reviews) were completed by Cotiviti, in Region 2, on or before Friday, September 16, 2022.

CMS anticipates Performant will begin reviews in the Spring (2023). RAC Region 2 providers can rely on the review completion date specified in the review results letter, as well as the RAC’s name on the letter, to identify which contractor to reach for inquiries.  If Performant receives inquiries in regards to reviews conducted by Cotiviti, Performant customer service will inform providers to reach out to Cotiviti and vice versa.

Region 2 Contact Information:

Cotiviti, LLC

www.Cotiviti.com/RAC

RACinfo@Cotiviti.com

1-866-360-2507

Performant Recovery, Inc.

https://Performantrac.com/providerportal.aspx

info@Performantrac.com

1-866-201-0580

 

March 26, 2021 - CMS awarded Performant Recovery, Inc., the incumbent, the new RAC Region 1 contract.

 

 

 

Page Last Modified:
09/10/2024 06:21 PM