CMS Announces Next Round of Recovery Audit Contractors

CMS Announces Next Round of Recovery Audit Contractors

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On October 31, 2016, the Centers for Medicare and Medicaid Services (CMS) announced the awards for the Medicare Fee-for-Service (FFS) Recovery Audit Contractor (RAC) contracts. The five regions include:

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

Pennsylvania is under Region 4. Maps depicting the new regions and related RACs are available in the “Downloads” section of the Future Changes page on CMS’ website.

The RACs in Regions 1–4 will perform post-payment reviews to identify and correct Medicare claims that contain improper payments (overpayments or underpayments), made under Part A and Part 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 post-payment review of DMEPOS and Home Health/Hospice claims nationally. These awards continue the implementation of many of the Recovery Audit Program enhancements designed to reduce provider burden, enhance program oversight, and increase transparency in the program. CMS will continue to update this website with more information on the implementation of the new RACs.

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