Recovery Audit Contractor (RAC) - JE Part A
Recovery Audit Contractor (RAC)
Recovery Audit Contractors (RAC) 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.
RACs identify specific issues to pursue but 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 Audit Contractor requests sample data to supply to CMS on an issue the RAC would like approved. Prior to a widespread review, all approved issues are posted on the Recovery Audit Contractor’s website. Noridian urges providers to stay informed of the new issues that are identified by the RAC contractor.
Contact - Cotiviti, CMS and Noridian - View contact information including website and email.
Types of Reviews - View the three types of Recovery Auditor reviews and the action providers should take.
New Issues (cotiviti.com) - View current projects.
Recovery Audit Contractor Demand Letters Issued by Medicare Contractors - View the information regarding demand letters, sending a Part A overpayments check, overpayment interest rates, the extended repayment schedule and requesting an immediate offset.
Recovery Audit Contractor Determinations - Agree or Disagree - Agree or disagree with the Recovery Auditor determination? Check out your options.
Note: The Noridian Provider Contact Center is only able to answer general questions about the RAC program. Providers are advised to contact the Recovery Audit Contractor directly with inquires related to their activities.
- Cotiviti - Region 4 Recovery Auditor
- Identifying Which Entity Completed a Part A Claim Review
- CMS Additional Documentation Limits for Medicare Institutional Providers
- CMS Medicare Fee for Service Recovery Audit Program
- CMS Statement of Work for the Part A/B Medicare Fee-for-Service Recovery Audit Program - Regions 1-4