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.

RAC Topic

Showing 31-40 of 151 entries
Issue Name Review Type Provider Type MAC Jurisdiction Date Approved
0054 - Ambulance Billed during Inpatient: Unbundling Automated Laboratory/Ambulance All A/B MACs
0056 - Evaluation and Management Services in Skilled Nursing Facilities: Incorrect Coding Automated Professional Services All A/B MACs
0060 - Untimed Therapy: Excessive Units Automated Comprehensive Outpatient Rehabilitation Facility (CORF); Outpatient Hospital; Outpatient Rehabilitation Facility (ORF); Professional Services; Skilled Nursing Facility All A/B MACs
0061 - Nursing Facility Services: Excessive Units Automated Professional Services All A/B MACs
0062 - Radiology: Technical Component during Inpatient Stay Automated Professional Services All A/B MACs
0064 - Facility Duplicate Claims Automated Inpatient Hospital; Outpatient Hospital; Skilled Nursing Facility (SNF) All A/B MACs
0065 - Continuous Positive Airway Pressure Machine without an Obstructive Sleep Apnea Diagnosis Automated DME Physician/ DME Supplier All DME MACs
0067-Inpatient Psychiatric Facility Services: Medical Necessity and Documentation Requirements Complex Inpatient Hospital; Inpatient Psychiatric Facility (IPF) All A/B MACs
0069 - Respiratory Assist Devices: Medical Necessity and Documentation Requirements Complex DME Physician/ DME Supplier All DME MACs
0072 - Outpatient Service Overlapping or During an Inpatient Stay: Duplicate Payments Automated Outpatient Hospital All A/B MACs
Page Last Modified:
11/19/2024 05:55 PM
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