CMS RAC Provider Resources
Use the Provider PortalLogging in & navigation
Submit DocumentationMethods & formatting requirements
Submit a Discussion RequestFillable Discussion Request Form
Update Your Contact Information - Individual ProviderAddress, fax, email, contact of record
Update Your Contact Information - Multi-ProviderAddress, fax, email, contact of record
All CMS-approved reviews by type & state
RAC Frequently Asked QuestionsThorough answers to quick questions
PIP Frequently Asked QuestionsFor Periodic Interim Payment providers
Updates and News
Change to Provider’s Discussion Period
There are a number of changes to the Recovery Audit program effective January 1, 2016. One of those changes is the length of time a Provider has to submit a Discussion Request following a RAC review. Two important alerts:
(1) The Provider has the option to submit a Discussion Request within 30 days from the date of the Review Results Letter for a Complex review, and within 30 days from the date of the Portal notification for an Automated review. During this period we will not submit an adjustment to your Payer. We encourage all providers to utilize the Discussion process if there is additional information/documentation that you believe would change the outcome of our review.
To do so, please utilize our updated Discussion Request Form on this page above. For your convenience, the form can be completed electronically and directions for submission are on the form itself. Please note that the Recovery Auditors are not required to entertain discussion requests submitted greater than 30 days after the date of Review Results Letter for Complex reviews or 30 days after the date of the Portal notification for Automated reviews.
(2) We will display Automated review findings on the Provider Portal as soon as they become available. (Previously they were not displayed until the Payer validated they were going to make the subsequent adjustment.) The Status Effective Date will start the 30-day period described above.
For additional information on all of the changes to the Recovery Audit program, please click here to view the CMS publication.
Change to Facility Medical Record Request Limits
The new Medical Record Request Limits for facilities are effective with any Additional Documentation Request (ADR) letters dated January 1, 2016 or later. (ADR’s issued prior to January 1, 2016 adhere to the prior CMS guidelines.) There are significant changes to the prior methodology for calculating these limits. One of the most significant changes is that CMS, not the Recovery Auditors, will calculate the limits and the limits are calculated by NPI – not by campus. Limits are also subject to change based on NPI-specific audit results. For additional information including other changes to the Recovery Audit program effective January 1, 2016, please click here to view the CMS publication.
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