Quick guide to the Medicare Recovery Audit Contractor (RAC) Program.

1. No Need to “RAC” Your Brain!
Published by Medical Business
Systems Practice
Management
Software.
Quick Guide to the Medicare Recovery
Audit Contractor (RAC) Program

2. The purpose of the RAC
program is to identify and
correct both over- and
underpayments .
Audits from 2005 -2008
Recovered over $900
million in
overpayments
Reimbursed
providers $38 million
in underpayments
Typical causes of improper payments:
1. Incorrect payment amounts
2. Non-covered services
3. Incorrectly coded services
4. Duplicate services
The ultimate goal is to
provide CMS with
payment analysis that will
prevent future improper
payments.
Records are
reviewed in the US
by: certified
coders, nurses, the
rapists, and a
physician
(CMD)

3. The US and it’s territories are divided into 4 RAC Jurisdictions.
A
Performant Recovery
www.Performantrac.com
Info@performantrac.com
1‐866‐201‐0580
B
CGI
States:
CT, DE, DC, ME, MD, MA
, NH, NJ, NY, PA, RI and
VT.
Connolly, Inc.
HealthDataInsights
http://racb.cgi.com
racb@cgi.com
1‐877‐316‐7222
States:
IL, IN, KY, MI, MN, OH
and WI.
C
www.connollyhealthcare.com/RAC
RACinfo@connollyhealthcare.co
1‐866‐360‐2507
States:
AL, AR, CO, FL, G
A, LA, MS, NM, N
C, OK, SC, TN, TX
, VA, WV, Puerto
Rico and U.S.V.I.
D
States:
AK, AZ, CA, HI, ID,
IA, KS, MO, MT, ND http://racinfo.healthdatainsights.com
racinfo@emailhdi.com
, NE, NV, OR, SD,
Part B: 866‐376‐2319
UT, WA, WY, Guam
, American Samoa
and Northern
Marianas.

4. Demand letters
are sent from
the MAC and
interest is
accrued from
the accounts
receivable/letter
date.
The RAC is required to
provide detailed results with
the rationale used to arrive at
the determination.
Do you have questions or comments about the
Recovery Audit Program?
You can e-mail CMS at: RAC@cms.hhs.gov.
Recovery Auditors are
required to post on
their websites the
CMS-approved issues
that may trigger a
Recovery
Auditor
review.
Source
CMS.gov