Recovery Audit Contractor (RAC) Regions 3, 4, & 5

The Recovery Audit Program’s mission is to reduce Medicare improper payments through the efficient detection and correction of improper payments. This requirement includes all tasks and responsibilities associated with the review of Medicare Fee-for-Service (FFS) claims submitted to, and paid by, the A/B Medicare Administrative Contractors (MAC) in RAC Regions 3 and 4, and Region 5 which includes Durable Medical Equipment, Prosthetics, Orthotics, and Supply (DMEPOS) claims and Home Health/Hospice (HH/H) claims.

The RAC shall review all applicable claim types submitted to a MAC through the appropriate review methods and work with the Centers for Medicare & Medicaid Services (CMS) and MACs to effectuate the adjustment of claims, recoupment of overpayments, payment of underpayments, support the appeals process and report the status of all reviews by updating the RAC Data Warehouse (RACDW) and providing monthly reports.

The RACs review all applicable claim types submitted to an A/B MAC through the CMS approved review methods and work with CMS and MACs to adjust claims appropriately based on review findings, support the appeals process, and report all statuses. To facilitate the review and adjudication of claims, the RACs are required to have Joint Operating Agreements (JOAs) with all applicable Medicare contractors (MACs, UPICs, QICs, AdQIC) and any other CMS partners as instructed by CMS