ºÚÁÏÕýÄÜÁ¿

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

04/06/10 -

02/01/10 - Sample RAC Correspondence

01/29/10 -

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

03/24/09 -
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 - 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.

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.

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 .

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:

and all revisions

Presolicitation, Aug 16, 2007

Aug 16, 2007

Oct 19, 2007 Solicitation

Nov 07, 2007

Nov 19, 2007

Nov 28, 2007

Dec 07, 2007

and all revisions

Presolicitation, Aug 04, 2004

Aug 04, 2004

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

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

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

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

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

CMS RAC Program Status Documents

, 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