Medicare Recovery Audit Contractors (RACs)
A Guide for Audiologists and Speech-Language Pathologists
The Medicare Recovery Audit Program was designed to identify and reduce improper payments. Four RACs are each responsible for identifying overpayments and underpayments in approximately one quarter of the country, divided geographically. In 2013, the manual medical review process for Medicare Part B therapy claims over $3,700 was added to the RAC scope of work.
RACs are paid on a contingency fee basis, which means they are reimbursed based on a percentage of the improper payments they find or collect. The amount of the contingency fee is based on the amount of money from, or reimbursed to, providers. The fee is paid once the money has been recouped or refunded, not when the improper payment is first identified. The RACs must return the fee if an overpayment/underpayment is overturned at any level of appeal.
The RACs offer a period of discussion to allow providers the opportunity to discuss or submit additional documentation prior to initiating the appeals process. Providers receiving a demand letter and/or review results letter can ask to speak to a physician at the RAC. The request must be acted upon by the RAC. All discussion requests should be in writing and shall be responded to by the recovery auditor within 30 days of receipt. The appeals process may not be initiated during the discussion period. If, during the discussion period, the RAC is notified by another contractor that the provider initiated the appeals process, the RAC will immediately discontinue the discussion period.
See also: Medicare Audits and Program Integrity
Regional RAC Information
Information regarding the electronic tracking system for the claims review and appeals process is available at the following sites:
||Provider Portal Requirements
CT, DE, DC, MA, MD, ME, NH, NJ, NY, PA, RI, VT, VA
**Only for the Counties of Arlington and Fairfax and the City of Alexandria. For the rest of VA, see Connolly, Inc.
|Provider login is from 1st additional documentation request (ADR) letter received
|CGI Federal, Inc.
||IL, IN, KY, MI, MN, OH, WI
||Provider login—Medicare ID or NPI
AL, AR, CO, FL, GA, LA, MS, NC, NM, OK, SC, TN, TX, VA*, WV, Puerto Rico, U.S. Virgin Islands
*Excludes the Counties of Arlington and Fairfax and the City of Alexandria. For these localities, see Performant Recovery.
|State and NPI required
||AK, AZ, CA, HI, IA, ID, KS, MO, MT, NE, ND, NV, OR, SD, UT, WA, WY, Guam, American Samoa, N. Marianas
Registration (user ID and password)
Knowledge-based claim-by-claim (requires NPI, Medicare ID, exact dollars and cents amount of the claim, patient date of birth)