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

The contract pertains to the Recovery Audit Program aimed at minimizing improper Medicare payments by identifying and correcting payment errors efficiently. It covers all tasks related to reviewing Medicare Fee-for-Service claims submitted to and paid by Medicare Administrative Contractors (MACs) across Regions 3, 4, and 5, including claims for Durable Medical Equipment, Prosthetics, Orthotics, Supplies (DMEPOS), and Home Health/Hospice services. The Recovery Audit Contractors (RACs) are responsible for examining all relevant claim types using CMS-approved review methods, working collaboratively with CMS and MACs to adjust claims based on review findings, recover overpayments, process underpayments, and support appeals. They are also tasked with reporting review statuses through the RAC Data Warehouse and providing monthly updates. To facilitate seamless review and adjudication, RACs must establish Joint Operating Agreements with all relevant Medicare contractors and CMS partners as directed. The contract is issued by the Office of Acquisition and Grants Management within the Department of Health and Human Services, located in Baltimore, Maryland. It emphasizes collaboration with CMS and other Medicare entities to ensure accurate claim adjustments and proper management of payments. The solicitation number is 75FCMC25RJ003, with a response deadline set for January 6, 2025. The contract emphasizes compliance with federal procurement standards and aims to enhance the integrity of Medicare payments through systematic audits and reviews. Contact persons for the contract include Nicole Hoey and Megan Anuszewski, with their contact details provided for further inquiries.