Solicitation - 75FCMC25RJ003.zip

This is a solicitation file for Recovery Audit Contractor (RAC) services for Regions 3, 4, and 5, issued by the Centers for Medicare and Medicaid Services (CMS) under solicitation number 75FCMC25RJ003. The requirement focuses on reviewing Medicare Fee-for-Service (FFS) claims submitted to and paid by A/B Medicare Administrative Contractors (MAC) in the specified regions, with Region 5 specifically covering Durable Medical Equipment, Prosthetics, Orthotics, and Supply (DMEPOS) claims and Home Health/Hospice (HH/H) claims.

The selected contractor will be responsible for detecting and correcting improper Medicare payments through approved review methods, working with CMS and MACs to adjust claims, recoup overpayments, process underpayments, and support appeals processes. Key requirements include maintaining Joint Operating Agreements (JOAs) with Medicare contractors (MACs, UPICs, QICs, AdQIC) and other CMS partners, as well as reporting status updates through the RAC Data Warehouse (RACDW) and monthly reports. The overall mission is to reduce Medicare improper payments through efficient detection and correction processes.