Recovery Audit Contractor (RAC)

Recovery Audit Contractors

All information found here and all information on this page is subject to change (2012).

 

Recovery Audit Contractors (RACs) and Medicare: The Who, What, When, Where, How and Why?

Each Recovery Auditor is responsible for identifying overpayments and underpayments in approximately ¼ of the country.  Their contingency fees can be found here.  The Recovery Audit jurisdictions will match the DME MAC Jurisdictions.

 

Recovery Audit Contractor Information (Medicare)

RAC

Website

E‐mail

Telephone Number

Region A: Diversified Collection

Services

States: CT, DE, DC, ME, MD, MA, NH, NJ, NY, PA, RI and VT.

www.dcsrac.com

info@dcsrac.com

1‐866‐201‐0580

Region B: CGI

States: IL, IN, KY, MI, MN, OH and

WI.

http://racb.cgi.com

racb@cgi.com

1‐877‐316‐7222

Region C: Connolly, Inc.

States: AL, AR, CO, FL, GA, LA, MS, NM, NC, OK, SC, TN, TX, VA, WV, Puerto Rico and U.S. Virgin Islands.

www.connollyhealthcare.c

om/RAC

RACinfo@connollyhealthcare.

com

1‐866‐360‐2507

Region D: HealthDataInsights

States: AK, AZ, CA, HI, ID, IA, KS, MO, MT, ND, NE, NV, OR, SD, UT, WA, WY, Guam, American Samoa and Northern Marianas.

http://racinfo.healthdatai

nsights.com

racinfo@emailhdi.com

Part A: 866‐590‐5598

Part B: 866‐376‐2319

State Medicaid RACS are tasked with identifying and recovering Medicaid overpayments and identifying underpayments. 

 

This page includes programs and information that have been updated within the past 60 days.

March 26, 2012

Beginning April 1, 2012, CMS will begin instituting a reimbursement cap of $25 per medical record. Any medical record submitted to a Recovery Auditor after  April 1, 2012 will receive a maximum of $25 per medical record. This includes both the $0.12 per-page cost for photocopying, as well as first class postage.

August 16, 2012

The Prepayment Review Demonstration now has its own Web page and shortened URL as follows: http://go.cms.gov/racprepay

 

CMS’ Provider Compliance Page provides educational products that assist FFS providers on how to avoid common billing errors.

 

Limitation on Recoupment for Provider, Physicians and Suppliers Overpayments

CR 6183, from which this article is taken, announces changes to the physician, provider, and supplier overpayment recoupment process, as required by Section 935 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) which amended Title XVIII of the Social Security Act to add to Section 1893 a new paragraph (f) addressing this process. See MLN Matters article MM6183 for more information.

 Know where previous improper payments have been found and look to see what improper payments were found by the RACs:

Demonstration findings: www.cms.hhs.gov/rac

Permanent RAC findings: will be listed on the RACs’ websites

Look to see what improper payments have been found in OIG and CERT reports

OIG reports: www.oig.hhs.gov/reports.html

CERT reports: www.cms.hhs.gov/cert

There are five levels in the claims appeals process under original Medicare:

1. Redetermination by a CMS contractor (carrier, fiscal intermediary or Medicare Administrative Contractor (MAC))

2. Reconsideration by a Qualified Independent

Contractor (QIC)

3. Hearings before an Administrative Law Judge (ALJ) within the Office of Medicare Hearings and Appeals in the Department of Health and Human Services

4. Review by the Appeals Council within the Departmental Appeals Board in the Department of Health and Human Services.

5. Judicial review in federal district court.

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