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Recent Updates

April 20, 2018 - Medicare FFS Recovery Audit Contractors (RACs) are approved by CMS to review Periodic Interim Payment (PIP) Providers under CMS New Issue #0001 MS-DRG Validation. PIP Provider claims that are selected for review will have ADRs sent within 6 months of the date of services.

January 29, 2018 – An updated version of the Institutional Provider (Facilities) ADR Limit document is available in the Downloads area of the Provider Resource webpage. The updated version includes additional information on how Provider Denial Rates are calculated, for Risk-Based, Adjusted ADR Limits.

November 24, 2017 - An updated document, listing the Recovery Audit Program Improvements and their respective implementation (effective) dates is now available in the Download area of the Program Reports webpage.

November 9, 2017 – CMS has begun, as of today, to post a list of review topics that have been proposed, but not yet approved, for RACs to review. These topics will be listed, on a monthly basis, on our Provider Resources page along with details about the proposed reviews, such as:

  • Name of the Review Topic
  • Description of what is being reviewed
  • State(s)/MAC regions where reviews will occur
  • Review type (complex review/automated review)
  • Provider type
  • Affected code(s)
  • Applicable policy references.

December 7, 2016 - CMS has posted the Fiscal Year 2015 Recovery Audit Program Report to Congress in the Downloads section of the Recovery Audit Program’s main page. CMS has also posted the FY 2015 Recovery Audit Program Appendices, as a companion to the Report.

October 31, 2016CMS has awarded the next round of Medicare Fee-for-Service Recovery Audit Contractor (RAC) contracts to:

Region 1 – Performant Recovery, Inc.

Region 2 – Cotiviti, LLC

Region 3 – Cotiviti, LLC

Region 4 – HMS Federal Solutions

Region 5 – Performant Recovery, Inc.

Maps depicting the new regions and related RACs are available in the ‘Downloads’ section of our Provider Resources page.

The RACs in Regions 1-4 will perform postpayment review to identify and correct Medicare claims that contain improper payments (overpayments or underpayments) that were made under Part A and Part B, for all provider types other than Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) and Home Health/Hospice. The Region 5 RAC will be dedicated to the postpayment review of DMEPOS and Home Health/Hospice claims nationally. These awards continue the implementation of many of the Recovery Audit Program enhancements designed to reduce provider burden, enhance program oversight, and increase transparency in the program. CMS will continue to update this website with more information on the implementation of the new RACs.

Do you have questions or comments 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.

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