Recovery Audit Contractor (RAC) Regions 3, 4, & 5

The Centers for Medicare & Medicaid Services (CMS) is seeking Recovery Audit Contractors (RACs) for Regions 3, 4, and 5 to review Medicare Fee-for-Service claims and identify improper payments. The solicitation (No. 75FCMC25RJ003) requires contractors to detect and correct overpayments and underpayments for claims submitted to Medicare Administrative Contractors, with Region 5 specifically focusing on Durable Medical Equipment, Prosthetics, Orthotics, and Supply claims, and Home Health/Hospice claims. The evaluation will use a lowest-price technically acceptable approach, assessing six technical factors on a pass/fail basis, including legislative requirements, improper payment identification, website/portal capabilities, quality assurance, IT systems, and key personnel qualifications. Key dates include a draft RFP release on November 22, 2024, with draft RFP questions due by December 13, 2024, and final proposals due by February 18, 2025. Contractors must comply with strict CMS requirements, including maintaining Joint Operating Agreements with Medicare contractors and updating the RAC Data Warehouse with review statuses.

The solicitation does not include any specific set-aside designations for small businesses. The contract will be a firm-fixed contingency fee type with an 8.5-year base period (May 1, 2025 - October 30, 2033) and an 18-month administrative/appeals option period. Contractors will only be paid from recovered overpayments after claims successfully exit the second level of appeals or pass the 120-day provider appeal window. The place of performance is the United States, with contractors required to have key personnel including a Project Manager, Contractor Medical Director, Medical Review Manager, Chief Information Officer, and Systems Security Officer. The procurement anticipates awarding three separate contracts, one for each region, with contractors responsible for reviewing all provider types including inpatient/outpatient hospitals, skilled nursing facilities, home health, hospice, and DME suppliers. Contractors must maintain 95% accuracy rates and support appeals through the Administrative Law Judge level, with a requirement to obtain Authority to Operate (ATO) within 60 days of award.