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Linda Collins Blogger

Recovery Audit Contractors (RAC)

Posted by Linda Collins | March 28, 2019

Guest Author: Tina Mejia-Smith, Director of Compliance, Össur

If you recently received a notice from Performant Region 5 Recovery Audit Contractor (RAC) informing you that one (or more) of your payments have been identified as an improper payment, it is because via data analysis RAC has identified your payment as falling under one of the CMS Approved Audit Issues and likely been paid an in error.  It is important you review the list of all Performant Approved Audit issues and respond within the stated timelines if you receive a notice.

As of today, several issues have been approved for RAC review including Spinal Orthosis: TLSO/LSO with the Reasonable Useful Lifetime (Automated Review), Off-the-Shelf Knee Orthosis (Complex Review),  Custom Fabricated Knee Orthosis (Complex Review) and Complex Spinal Orthoses (Complex Review).  For information on review types, appeals, timeline and medical record submissions carefully review the Performant published Frequently Asked Questions.

Important Links:

Performant Approved Audit Issues

Performant Frequently Asked Questions by Providers

R&R-New Audit Issue: Spinal Orthosis

R&R-OA Knee Bracing Medical Necessity Requirements

R&R-FAQs: The 48 Hour Rule

R&R- New Recovery Auditor Issue for Knee Orthoses


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If you have any questions for Össur’s Reimbursement Team or about Össur’s Reimbursement Services, please contact us at [email protected]