Resources from CMS on the RAC program
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.
04/06/10 - CMS hosts RAC 101 Calls
02/01/10 - Sample RAC Correspondence
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 http://www.cms.hhs.gov/rac/
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
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