RAC Audit


Recovery Audit Contractor (RAC) Audits

The Centers for Medicare and Medicaid Services (CMS), placed all the activities of the four existing Recovery Audit Contractors (RAC) contractors on hiatus as a result of the upcoming award of new RAC contracts. This hiatus was to allow for a smooth transition to the new RAC contractors, including the single, national RAC (Region 5 RAC) contractor that will solely focus on claims for DMEPOS, Home Health, and Hospice services when the new contracts are awarded.

On Monday, October 31, 2016 CMS announced the awarding of the new contracts for the Region 5 RAC, and the contract was awarded to Performant Recovery, Inc. (Performant Recovery was the RAC for Jurisdiction A.)

CMS is confident that the awarding of the new RAC contracts “will continue to reduce provider burden, enhance program oversight, and increase transparency in the program.” It is not known when the new contracts will take effect and when Performant will begin its duties as the single RAC for O&P claims.

The Region 5 RAC statement of work may be found here.

Enhancements to the RAC Program

View recent and future changes to the RAC program here.

 Additional Documentation Requests: RAC Audit Limits for O&P

As originally reported in the April 4, 2013 SmartBrief, AOPA’s continuing conversation and efforts to convince CMS of the cash flow killing harm to patient care and member patient care facilities imposed by the pervasive and aggressive RAC audits together with aggressive AOPA member advocacy with their legislators flowing from the Policy Forum resulted in a modification of RAC Additional Documentation Requests (ADRs) specific to suppliers categorized under the following supplier taxonomy codes:

52—Medical Supply Company with Prosthetist
53—Medical Supply Company with Orthotist-Prosthetist
56—Individual Certified Prosthetist
57—Individual Certified Prosthetist-Orthotist

For suppliers who are classified in these categories, CMS has implemented a limit of no more than 10 ADR requests per 45 days. AOPA contacted CMS and asked it to consider similar limitations for providers who are classified under the following taxonomy codes:

51—Medical Supply Company with Orthotist
55—Individual Certified Orthotist

AOPA received a prompt response from CMS and is pleased to announce that CMS has agreed to add supplier codes 51 and 55 to the list of taxonomy codes that are limited to no more than 10 ADRs.

RAC Report to Congress

Click here to view the most recent RAC report to Congress.

More About the RAC Program

To find the latest updates, visit CMS’ site about RAC Audits.