Recovery Audit Contractor (RAC) Program - CMS RAC Resources

Resources from CMS on the RAC program

CMS Resources

Medicare Fee-for-Service Recovery Audit Program
Additional Documentation Limits for Medicare providers
(except suppliers and physicians)

Beginning March 15, 2012

CMS Provider Compliance Website. Contains educational products that inform Medicare Fee-For-Service (FFS) providers about how to avoid common billing errors and other improper activities when dealing with the Medicare Program.

Get CMS' Recovery Audit Contractor (RAC) e-mail updates

04/29/10 - CMS hosts call on Section 935 Limitation on Recoupment

04/06/10 - CMS hosts RAC 101 Calls

02/01/10 - Sample RAC Correspondence

01/29/10 - CMS issues Additional Documentation Requests policy

05/28/09 - CMS sample demand letter provided to RACs

03/24/09 - CMS launches educational sessions on RAC program
CMS has launched its first regional outreach sessions for on the permanent Medicare recovery audit contractor program. The educational sessions are being conducted by CMS and the RACs for states in the first phase of the national roll out of the permanent RAC program.

09/29/08 - CMS posted a RAC Demonstration update on RAC appeals information, which reports on appeals activity through June 30, 2008. The prior CMS' RAC Demonstration report issued on July 11 included appeals data through March 27, 2008. This update is available at

07/11/08 -CMS Releases New RAC Demonstration Report which provides the most complete overview to date of the demonstration program and improvements CMS has planned for the permanent program scheduled to rollout this summer.

CMS RAC Web Site
This Web site has the latest information about the RAC demonstration and permanent programs from CMS.

11/19/07 -CMS RAC Frequently Asked Questions
This Web site features Recovery Audit Contractor (RAC) Solicitation Questions and Answers from November 2007.

Medicare Claims Review Program (MR, NCCI Edits, MUEs, CERT and RAC):
This booklet provides an overview of the several initiatives implemented by CMS to prevent improper payments before a claim is processed and identify and recoup improper payments after a claim has been processed. To access this new product, visit the CMS website.

CMS' Medically Unlikely Edit (MUE) Web Site
The CMS developed Medically Unlikely Edits (MUEs) to reduce the paid claims error rate for Part B claims. An MUE for a HCPCS/CPT code is the maximum units of service that a provider would report under most circumstances for a single beneficiary on a single date of service. All HCPCS/CPT codes do not have an MUE. MUE was implemented January 1, 2007 and is utilized to adjudicate claims at Carriers, Fiscal Intermediaries, and DME MACs. This webpage has links to CMS CRs and MUE Questions and Answers which explain most aspects of the MUE program.

RAC Program Statement of Work:

CMS Statement of Work and all revisions

Original Synopsis Presolicitation, Aug 16, 2007

Changed Aug 16, 2007

Changed Oct 19, 2007 Solicitation

Changed Nov 07, 2007

Changed Nov 19, 2007

Changed Nov 28, 2007

Changed Dec 07, 2007

RAC Demonstration Statement of Work and all revisions

Original Synopsis Presolicitation, Aug 04, 2004

Changed Aug 04, 2004

Changed Sep 09, 2004Award Mar 29, 2005 HealthDataInsights,2620 Regatta Drive, Suite 208B, Las Vegas, NV 89128-6896

Award Mar 29, 2005 PRG-Schultz,600 Galleria Parkway, Suite 100, Atlanta, GA 30339

Award Mar 29, 2005 Diversified Collection Services, Inc.,333 North Canyons Parkway, Suite 100,

Award Mar 29, 2005 Public Consulting Group,148 State Street, 10th Floor, Boston, MA 02109

Award Mar 29, 2005 PRG-Schultz,600 Galleria Parkway, Suite 100, Atlanta, GA 30339 (with changes)

CMS RAC Program Status Documents

CMS RAC Status Document FY 2007, 02/28/08
This status report focuses on the operations and findings of the Demonstration Claim RAC Program during fiscal year (FY) 2007 (from October 1, 2006 - September 30, 2007). This report excludes data on the Medicare Secondary Payer (MSP) RAC Program.

CMS RAC Status Document FY 2006, 11/22/06
This document describes the operations and findings of the CMS RAC program during fiscal year (FY) 2006 (i.e., between October 1, 2005 and September 30, 2006).

Other CMS Information and Resources on RACs

CMS' Response Letter to Rep. Lois Capps regarding the RAC demonstration project and the review of IRF claims in California, 12/07/07

Letter's Enclosure