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Recovery Auditor

Recovery Auditors, or RAs, were previously referred to as Recovery Audit Contractors or RACs. The mission of the Recovery Audit Program is to identify improper Medicare payments made on healthcare claims. These audits may result in the identification of Medicare overpayments and/or underpayments. Providers that may be reviewed include hospitals, physician practices, nursing homes, home health agencies, durable medical equipment suppliers and any other provider or supplier that bills Medicare Part A and Part B.

RAs identify specific issues to pursue, however are RAs are limited to claims approved through the CMS "new issue review" process. In some cases, a small number of "non-posted issue" requests may be requested from providers as the Recovery Auditor requests sample data to supply to CMS on an issue the RA would like approved. Prior to a widespread review, all approved issues are posted on the Recovery Auditor's website. Noridian urges providers to stay informed of the new issues that are identified by the RA contractor.

The Noridian Provider Contact Center can only answer general questions about the Recovery Auditor program. Medicare providers are advised to contact the Recovery Auditor directly with questions or comments concerning Recovery Auditor activities.

Topic Description
Contact – HDI, HMS, CMS and Noridian View contact information including website, address and email are provided.
Types of Reviews View the three types of Recovery Auditor reviews and the action providers should take.
Recovery Auditor Demand Letters Issued by Medicare Contractors As of January 3, 2012, CMS transferred the responsibility for issuing demand letters to providers from its Recovery Auditors to the claim processing contractors (Noridian).
Recovery Auditor Determinations - Agree or Disagree Agree or disagree with the Recovery Auditor determination? Check out your options.

Resources

Last Updated Jan 10, 2017

New Issues Available on HDI Website

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