RAC Region 2   3

The Recovery Audit Program's mission is to reduce Medicare improper payments through the efficient detection and correction of improper payments. The purpose of this statement of work (SOW) includes all tasks and responsibilities associated with the review of Medicare Fee-for-Service (FFS) claims submitted to, and paid by, the A/B Medicare Administrative Contractors (MACs) in RAC Region 2 (see map in the Appendices section). This excludes Durable Medical Equipment, Prosthetics, Orthotics, and Supply (DMEPOS) claims, and Home Health/Hospice (HH/H) claims. The RAC shall review all applicable claim types submitted to an A/B MAC through the appropriate review methods and work with the Centers for Medicare & Medicaid Services (CMS) and MACs to effectuate the adjustment of claims, recoupment of overpayments, payment of underpayments, support of the appeals process and reporting the status of all reviews by updating the RAC Data Warehouse (RACDW) and providing monthly reports in a timely, accurate, and efficient manner.