Do You Know Your Recovery Audit Contractors?

By
Original story posted on: March 6, 2013

With the ever-increasing scrutiny of providers by the Centers for Medicare & Medicaid Services (CMS), it becomes more and more difficult to keep track of all of the involved contractors. There are Medicare administrative contractors (MACs), durable medical equipment (DME) MACs, recovery audit contractors (RACs), zone program integrity contractors (ZPICs), and more. Knowing your contractors and how to contact them can be daunting. 

A recent RACmonitor article described a situation where a home health agency received a request for records from a RAC not authorized for its state. If someone had not realized that the discrepancy, agency staff could have sent, and possibly paid, to a contractor that had no right to see the records or demand payment. 

Finding your contractors and how to contact them used to require multiple searches through the CMS website. However, there is now an easier way.  CMS provides the Provider Compliance Group Interactive Map at http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Provider-Compliance-Interactive-Map/index.html.

This interactive map allows a provider or consultant to find state-specific contractor contact information (including emails, phone numbers and websites.) For instance, by clicking on the state of Louisiana, you will find contact information for the AB MAC, DME MAC, Home Health and Hospice, Railroad Retirement Board, Indian Health, MAC, and ZPIC, which is shown below as an example. The main page of the map provides contact information for national contractors such as the Part D RAC and National Benefit Integrity MEDIC.

AB Medicare Administrative Contractor (MAC)

Provider JH AB MAC IVR/CSR
Novitas Camp Hill
https://www.novitas-solutions.com
855-252-8782

Durable Medical Equipment Medicare Administrative Contractor (DME MAC)

Provider DME MAC Jurisdiction C IVR
CGS Nashville Regions
http://www.cgsmedicare.com
866-238-9650
Accepts esMD transactions

Provider DME MAC Jurisdiction C CSR
CGS Nashville Regions
http://www.cgsmedicare.com
866-270-4909
Accepts esMD transactions

Home Health and Hospice (HH+H)

Provider HH+H Jurisdiction C CSR
Palmetto GBA Alpine
http://www.palmettogba.com/medicare
866-830-3925

Provider HH+H Jurisdiction C IVR
Palmetto GBA Columbia
http://www.palmettogba.com/medicare
866-801-5301

Railroad Retirement Board (RRB)

Provider RRB IVR
Palmetto GBA Augusta
http://www.palmettogba.com/rr
877-288-7600

Provider RRB CSR
Palmetto GBA Augusta
http://www.palmettogba.com/rr
888-355-9165

Indian Health

Provider AB MAC Indian Health Services CSR
Novitas Camp Hill
http://www.novitas-solutions.com
855-252-8782

Division of Recovery Audit Operations (DRAO)

Region C Medicare Recovery Auditors
Connolly:
Connolly Healthcare RAC Office
The Navy Yard Corporate Center
One Crescent Drive, Suite 300-A
Philadelphia, PA 19112
racinfo@connollyhealthcare.com
http://www.connolly.com/healthcare/Pages/CMSRACProgram.aspx
866-360-2507
Accepts esMD transactions

Zone Program Integrity Contractors (ZPIC)

AdvanceMed Corporation
520 Royal Parkway, Suite 100
Nashville, TN 37214
http://www.nciinc.com
615-872-6706

Durable Medical Equipment Medicare Administrative Contractor (DME MAC)

Medical Review Jurisdiction C
CGS Administrators, LLC
P.O. Box 20010
Nashville, TN 37202
Ngs.cedihelpdesk@wellpoint.com
http://cgsmedicare.com/jc/index.html
1.866.270.4909 (customer service)
1.866.238.9650 (IVR - interactive voice response)
1.888.204.3771 (hearing impaired)
Accepts esMD transactions

Medicare Administrative Contractor (MAC)

This state has not yet transitioned to a MAC.

About the Author

Donna Richmond is a senior healthcare consultant with Panacea Healthcare Solutions, Inc.

Contact the Author

drichmond@panaceahealthsolutions.com

To comment on this article please go to editor@racmonitor.com

Discharge Summaries Take Center Stage; Risks Grow with Electronic Health Records

Donna Richmond, BA, RCC, CPC

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