Closed Solicitation · DEPARTMENT OF HEALTH AND HUMAN SERVICES
AI Summary
The Department of Health and Human Services is seeking a Recovery Audit Contractor (RAC) for Regions 3, 4, and 5 to reduce Medicare improper payments. The contractor will review Medicare Fee-for-Service claims, including DMEPOS and Home Health/Hospice claims, and collaborate with CMS and MACs for claims adjustments, overpayment recoupment, and appeals support. Interested bidders should note the NAICS Code 561440 and the solicitation deadline of February 18, 2025.
The Recovery Audit Programs 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 and 4, and Region 5 which includes 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 a 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 the appeals process and report the status of all reviews by updating the RAC Data Warehouse (RACDW) and providing monthly reports. The RACs review all applicable claim types submitted to an A/B MAC through the CMS approved review methods and work with CMS and MACs to adjust claims appropriately based on review findings, support the appeals process, and report all statuses. To facilitate the review and adjudication of claims, the RACs are required to have Joint Operating Agreements (JOAs) with all applicable Medicare contractors (MACs, UPICs, QICs, AdQIC) and any other CMS partners as instructed by CMS
RECOVERY AUDIT CONTRACTOR (RAC) REGIONS 3, 4, & 5 is a federal acquisition solicitation issued by DEPARTMENT OF HEALTH AND HUMAN SERVICES. Review the full description, attachments, and submission requirements on SamSearch before the response deadline.
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