What type of claims do Recovery Audit Contractors review?

Recovery Audit Contractors (RACs) primarily review post-payment claims. This process involves examining claims that have already been processed and paid by Medicare or other insurers to identify overpayments or underpayments. The aim is to ensure that payments made for services provided meet the established policies and regulations.

When examining post-payment claims, RACs look for coding errors, incorrect documentation, and compliance with Medicare guidelines. Their work is crucial for maintaining the integrity of the payment system and ensuring that funds are allocated appropriately.

In contrast, pre-payment claims are assessed before payment is made, which falls under a different type of auditing and oversight. Partial-payment claims refer to situations where only a portion of the billed amount is paid but are also not the focus of RAC reviews. Future payment claims are not relevant as RACs focus on claims that have already been settled. Thus, the specialized role of RACs is primarily concerned with claims that have already undergone payment processing to ensure accuracy and compliance.