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    CMS awards next round of RAC contracts

    The Centers for Medicare & Medicaid Services (CMS) awarded the next round of Medicare Fee-for-Service Recovery Audit Contractor (RAC) contracts. Under these contracts, RACs review medical records and find instances where Medicare is paying providers too much money. When a RAC identifies an overpayment, CMS then pays the RAC a contingency fee. Providers have the opportunity to appeal the RAC’s findings but a huge backlog of appeals has resulted in a multi-year appeal process that is a source of frustration to providers.

    On October 31, 2016, CMS awarded RAC contracts to the following four companies; notably, long-time contractor CGI Group is no longer included:

    • Region 1 – Performant Recovery, Inc.
    • Region 2 – Cotiviti, LLC
    • Region 3 – Cotiviti, LLC
    • Region 4 – HMS Federal Solutions
    • Region 5 – Performant Recovery, Inc. 

    The RACs in Regions 1-4 will perform postpayment review under Parts A and B for all provider types other than Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) and Home Health/Hospice. The Region 5 RAC will be dedicated to the postpayment review of DMEPOS and Home Health/Hospice claims nationally.

    This is for informational purposes only. It is not intended to be legal advice and does not create or imply an attorney-client relationship.

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