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Do RAC’s review claims paid by Medicare Advantage Managed Care plans?

No. The RAC reviews are limited to claims paid under the traditional Medicare Fee-for-Service program. Part D, prescription drug plan claims, are also excluded.

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Recovery Audit Contractors

RAC Scopes & Jurisdictions

Who is the RAC in my state?

Where can I learn what issues the RAC is reviewing?

Whose claims can be reviewed by the RAC?

Aren’t RAC’s focusing on hospital claims?

Do RAC’s review claims paid by Medicare Advantage Managed Care plans?

Do the RAC’s replace the other entities that review claims for accuracy of payment or investigate physicians' claims?

How far back can RAC’s look in reviewing claims?

Will RAC’s review claims for evaluation and management services?

RAC Review Criteria

How will RAC’s review claims for overpayments and underpayments?

What criteria will be used by the RAC’s in determining the medical necessity of services related to a claim?

RAC Recovery Requests

How can I identify a RAC recovery versus a request for refund from other sources?

If I disagree with an RAC’s overpayment findings, can I appeal?

Is there limitation on recovery of small overpayments found by the RAC?

Medical Record Review by the RAC

Must I allow the RAC to conduct an onsite review of my medical records?

If the RAC requests copies of my patient’s records, will I be paid a fee for my expenses in providing the records?

When a RAC requests copies of patient records, how long does a physician have to comply with the request?

Is there a limit to the number of records that the RAC may request from a physician or group practice?

Planning to Avoid RAC Issues

What should I do to protect my practice from RAC recovery efforts?

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