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 101-110 of 145 entries

Issue Name Sort descending	Review Type	Provider Type	MAC Jurisdiction	Date Approved
0160-Intravenous Immune Globulin for the Treatment of Autoimmune Blistering Diseases: Medical Necessity and Documentation Requirements	Complex	Ambulatory Surgical Center (ASC); Outpatient Hospital; Professional Services	All A/B MACs	2019-09-01
0161-Therapeutic, Prophylactic, and Diagnostic Infusions: Incorrect Coding and Documentation Requirements	Complex	Outpatient Hospital	All A/B MACs	2019-07-02
0164-Bilateral Indicator '3': Incorrect Coding	Automated	Professional Services	All A/B MACs	2019-09-10
0165-Positron Emission Tomography for Dementia and Neurodegenerative Diseases: Medical Necessity and Documentation Requirements	Complex	Outpatient Hospital; Professional Services	All A/B MACs	2019-09-10
0167-Ankle-Foot Orthoses and Knee-Ankle-Foot Orthoses within the Reasonable Useful Lifetime: Excessive Units	Automated	DME Physician/ DME Supplier	All DME MACs	2019-09-10
0169-Outpatient Services within 3 Days Prior to and Including the Date of a Hospital Admission: Unbundling	Automated	Outpatient Hospital	All A/B MACs	2019-12-01
0170-Renal and Peripheral Angiography: Medical Necessity and Documentation Requirements	Complex	Ambulatory Surgical Center (ASC); Outpatient Hospital; Professional Services	All A/B MACs	2019-12-01
0171-Erythropoiesis Stimulating Agents for Cancer Patients: Medical Necessity and Documentation Requirements	Complex	Outpatient Hospital; Professional Services	All A/B MACs	2019-12-03
0173-Surgical Dressings: Medical Necessity and Documentation Requirements	Complex	DME Physician/ DME Supplier	All DME MACs	2019-12-03
0174-Cervical Orthoses within the Reasonable Useful Lifetime: Excessive Units	Automated	DME Physician/ DME Supplier	DME MACs	2019-12-03