The Medicare Fee for Service (FFS) Recovery Audit Program’s mission is to identify and correct Medicare improper payments through the efficient detection and collection of overpayments made on claims of health care services provided to Medicare beneficiaries, and the identification of underpayments to providers so that the CMS can implement actions that will prevent future improper payments in all 50 states
- Region 1 (Vermont (VT), New Hampshire (NH), Maine (ME), Massachusetts (MA), Rhode Island (RI), Connecticut (CT), New York (NY), Washington DC, Michigan (MI), Indiana (IN), Ohio, (OH), Kentucky (KY)): Performant Recovery, Inc.
- Region 2 (Minnesota (MN), Wisconsin (WI), Illinois (IL), Iowa (IA), Nebraska (NE), Kansas (KS), Missouri (MO), Colorado (CO), New Mexico (NM), Oklahoma (OK), Texas (TX), Arkansas (AR), Louisiana (LA), Mississippi (MS)): Cotiviti, LLC.
- Region 3 (West Virginia (WV), Virginia (VA), Tennessee (TN), North Carolina (NC), South Carolina (SC), Georgia (GA), Alabama (AL), Florida (FL), Puerto Rico (PR), American Virgin Islands (AVI)) : Cotiviti, LLC.
- Region 4 (Washington (WA), Oregon (OR), Idaho (ID), Montana (MT), North Dakota (ND), South Dakota (SD), Wyoming (WY), Utah (UT), California (CA), Nevada (NV), Arizona (AZ), Hawaii (HI), Alaska (AK), Pennsylvania (PA), Maryland (MD), Delaware (DE), New Jersey (NJ)): HMS Federal Solutions
- Region 5 Durable Medical Equipment and Home Health Hospice: Performant Recovery, Inc.
The original Medicare FFS RACs will be under contract with CMS until 2018 for administrative purposes. Providers may still receive correspondence related to claims adjusted under the original RAC contracts.
Medicare FFS RAC Map
A map depicting the new regions can be viewed and downloaded.
Medical Record Submission Requirements
Medical records should be submitted to the RAC contractor within 45 days from the date of the medical record request letter. Medical records may be submitted by paper/fax/CD.
The RACs main task is to identify improper payments. The claims processing contractor (A/B MAC/DME MAC) is the entity that is responsible for adjusting the claim, handling collections (offsets and checks), and reporting the debt on the financial statements.