![]() At CMS discretion, CMS may require the RAC to review claims, based on these referrals. 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.Ĭotiviti, Recovery, 26, 2021 - CMS awarded Performant Recovery, Inc., the incumbent, the new RAC Region 1 contract.ĪpCMS often receives referrals of potential improper payments from the MACs, UPICs, and Federal investigative agencies (e.g., OIG, DOJ). 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. 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.ĬMS anticipates Performant will begin reviews in the Spring (2023). Please contact Cotiviti in regards to reviews conducted by Cotiviti. RAC Region 2 includes the following Medicare Administrative Contractor (MAC) jurisdictions: J5, J6, and JH.Ĭotiviti, 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. MaOn March 24, 2022, CMS awarded Performant Recovery, Inc., the new Recovery Audit Contractor (RAC) Region 2 contract. Review Type (complex review / automated review).States / MAC regions where reviews will occur.These topics will be updated monthly on the RAC reviews topic page and include: Stay in the know on proposed and approved topics that RACs are able to review. 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? ![]() Nationwide for in Regions 1-4 will perform post payment review to identify and correct Medicare claims specific to Part A and Part B. Virgin 4ĪK, AZ, CA, DC, DE, HI, ID, MD, MT, ND, NJ, NV, OR, PA, SD, UT, WA, WY, Guam, American Samoa and Northern A: 1-87 For more information regarding ADRs, please visit: Who are Recovery Audit Contractors? Recovery Audit Contractors RegionĬT, IN, KY, MA, ME, MI, NH, NY, OH, RI, and 2ĪR, CO, IA, IL, KS, LA, MO, MN, MS, NE, NM, OK, TX, and 3ĪL, FL, GA, NC, SC, TN, VA, WV, Puerto Rico and U.S. In order to obtain the medical record and any supporting documentation, the RAC shall issue an Additional Documentation Request (ADR). Automated reviews occur at the system level while complex reviews require a qualified individual to review the medical record. The RACs conduct both complex and automated post-payment reviews. What does a Recovery Audit Contractor (RAC) do? 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. For updates regarding Medicare Fee-For-Service (FFS) medical review during the 2019-Novel Coronavirus (COVID-19) Public Health Emergency (PHE), please visit: (PDF).ĭo you have questions or concerns about the Recovery Audit Program? Please e-mail us at Please Do Not send Personal Health Information to this e-mail address.
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