Which organization identifies improper payments made on CMS claims?

Which organization identifies improper payments made on CMS claims?

• A. Recovery Audit Contractor (RAC)
• B. Regional Audit Council
• C. Health Claims Review Board
• D. Payment Integrity Unit

Answer: (A)

The Recovery Audit Contractor program is CMS’s method for finding improper payments in claims. These contractors perform post-payment reviews of Medicare fee-for-service (and related CMS programs) to spot errors such as incorrect coding, duplicate or unallowable claims, and services not medically necessary. When improper payments are identified, CMS recovers the overpaid funds and uses the findings to strengthen billing rules and provider education, reducing future errors. The other names listed aren’t official CMS programs, so they don’t identify improper CMS claim payments.

The Recovery Audit Contractor program is CMS’s method for finding improper payments in claims. These contractors perform post-payment reviews of Medicare fee-for-service (and related CMS programs) to spot errors such as incorrect coding, duplicate or unallowable claims, and services not medically necessary. When improper payments are identified, CMS recovers the overpaid funds and uses the findings to strengthen billing rules and provider education, reducing future errors. The other names listed aren’t official CMS programs, so they don’t identify improper CMS claim payments.