The Centers for Medicare & Medicaid Services (CMS) is in an active procurement process for the next round of Medicare Fee-for-Service Recovery Audit Program contracts. In anticipation of this contract transition, CMS said it must ensure that the current Recovery Auditor Contactors (RACs) complete all outstanding claim reviews by the conclusion of the active recovery auditing phase of their contracts. The RACS must adhere to the following dates regarding current audits:
- May 16: The last day that a RAC could send additional documentation request (ADR) letters or semi-automated notification letters
- July 29: The last day that a RAC may send notification of an improper payment to providers. This includes sending a review results letter or no findings letter, and/or providing a portal notification to each provider.
- August 28: RACs will complete all discussion periods that are in process by this date. RACs continue to be required to hold claims for 30 days, starting with the date of the improper payment notification (via letter or portal) to the provider, to allow for discussion period requests.
- October 1: The last day a RAC may send claim adjustment files to the Medicare Administrative Contractors (MACs)
CMS advised that providers may still receive some correspondence related to the current RACs while it transitions to the new contracts. However, providers will not have to respond to ADRs more frequently than every 45 days, or from two different RACS.
CMS said it will continue to update its RAC program website with more information on the procurement and awards as information becomes available.
For more information or to ask questions concerning the transition, e-mail RAC@cms.hhs.gov.
