Closed Solicitation · DEPARTMENT OF HEALTH AND HUMAN SERVICES
AI Summary
The Department of Health and Human Services is seeking bids for the Recovery Audit Contractor (RAC) services in Regions 3, 4, and 5, with a focus on reducing improper Medicare payments. This contract involves reviewing Medicare Fee-for-Service claims processed by A/B Medicare Administrative Contractors, specifically targeting Durable Medical Equipment, Prosthetics, Orthotics, and Supply claims, as well as Home Health and Hospice claims. Contractors will be responsible for utilizing approved review methods to assess claims, facilitate adjustments, recoup overpayments, and address underpayments. Additionally, they will support the appeals process and maintain communication with the Centers for Medicare
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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