The five regional Recovery Audit Contractors (RACs) are ramping up their automated and complex reviews starting this month.  The Centers for Medicare & Medicaid (CMS) Medicare Fee for Service (FFS) audit program awarded contracts in October 31, 2016 to the following contractors:

Region 1 – Performant Recovery, Inc.

Region 2 – Cotiviti, LLC

Region 3 – Cotiviti, LLC

Region 4 – HMS Federal Solutions

Region 5 – Performant Recovery, Inc.

Post-payment reviews will identify the Part A and Part B improper payments for all providers in Region 1-4.

Region 5 RAC contractor Performant Recovery is unique in that it is nationally dedicated to perform post-payment reviews of Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) and Home Health and Hospice.

During these RAC calls it is important to note that  CMS Program Integrity drives these audits through combined sources such as Local Coverage Decisions (LCDs), National Coverage Decisions (NCDs), Program Integrity Manuals, as well as coding guidelines.

We at Context 4 Healthcare can provide you and your organization with a real-time web based Program Integrity Platform that will reduce audits, errors, and reduce cost. By utilizing our expertise in Program Integrity we can assure you that your claim submissions and in-house audit programs remain RAC compliant.

Let us assist you with your Program Integrity by contacting sales to see how Context 4 Healthcare’s Program Integrity Platform can help you.