Recovery Audit Contractor (RAC) Regions 3, 4, & 5

Background
The Recovery Audit Program's mission is to reduce Medicare improper payments through the efficient detection and correction of improper payments. This requirement 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 (MAC) in RAC Regions 3, 4, and 5.

The RAC shall review all applicable claim types using CMS-approved review methods and work with the Centers for Medicare & Medicaid Services (CMS) and MACs to adjust claims, recoup overpayments, pay underpayments, support the appeals process, and report the status of all reviews by updating the RAC Data Warehouse (RACDW) and providing monthly reports.

Work Details
The contractor will perform various tasks including: conducting initial meetings with CMS; developing a project plan; identifying improper payments on postpayment reviews; executing a claim review process; submitting review topics for approval; creating a website and provider portal; ensuring communication and collaboration with other Medicare contractors; conducting activities following reviews; utilizing the RAC Data Warehouse (RACDW); monitoring quality assurance and accuracy; supporting Medicare's third level of appeal processes; providing customer service and outreach to providers; conducting conference calls, meetings, and travel as necessary; and submitting monthly progress reports. The contractor must also maintain Joint Operating Agreements (JOAs) with applicable Medicare contractors.

Period of Performance
The period of performance for this contract will include an 8.5-year 'Active Recovery Auditing' base period from May 1st, 2025 to October 30th, 2033, followed by an 18-month 'Closeout and Reconciliation; Administrative and Appeals' option period from October 31st, 2033 to April 30th, 2035.

Place of Performance
The contract will be performed in Regions 3, 4, and 5 as designated by CMS.