Recovery Audit Contractor (RAC)
Recovery Audit Contractor
CMS contractors who identify and recover improper Medicare payments through review of paid claims.
1 min read · Last reviewed May 23, 2026
At a glance
- Category
- Denials & Appeals
- Acronym for
- Recovery Audit Contractor
- Primary sources
- 1
- Workspace handoff
- denial workbench →
Where this comes up
This is denial-workbench territory. A remit posts with a CARC/RARC, the biller decides whether to rebill, appeal, or write off, and the appeal packet has to cite the chart, the order, and the payer's own policy language. Recurring patterns trace back to an upstream workflow gap.
Full definition
What it is in practice
CMS RACs are paid on a contingency basis and target specific high-error issues each region. Findings can be appealed through the standard five-level Medicare process.
How it shows up in your practice
RACs typically focus on inpatient short stays, DRG validation, and high-volume CPT codes. Track CMS RAC issue postings and audit your own files for similar exposure.
Sources
- CMS — Recovery Audit Contractor (RAC) Programhttps://www.cms.gov/medicare/audits-compliance/recovery-audit-program
Defend RAC findings in the Denial Workbench
Open denial workbench →Related terms
- Denials & AppealsUPIC (Unified Program Integrity Contractor)CMS contractors that investigate and address fraud, waste, and abuse in Medicare and Medicaid.
- Denials & AppealsCERT (Comprehensive Error Rate Testing)The CMS program that measures the Medicare fee-for-service improper payment rate.
- Denials & AppealsMedicare Appeals LevelsThe five-level Medicare appeals process: Redetermination, Reconsideration, ALJ Hearing, Medicare Appeals Council, and Federal District Court.
D3rx is a healthcare-billing and compliance research aid maintained by D3rx Inc. Articles are drafted by an LLM (Anthropic Claude) against primary HHS, OCR, CMS, eCFR, NIST, and state-regulator publications, and reviewed for restraint and source fidelity by the D3rx team.
Reviewer status: a named credentialed reviewer (CHC, CHPC, or healthcare attorney) is being engaged. Until that engagement is finalized, this page does not claim credentialed review.
Related across the archive
- GlossaryCERT (Comprehensive Error Rate Testing)The CMS program that measures the Medicare fee-for-service improper payment rate.
- GlossaryMedicare Appeals LevelsThe five-level Medicare appeals process: Redetermination, Reconsideration, ALJ Hearing, Medicare Appeals Council, and Federal District Court.
- GlossaryUPIC (Unified Program Integrity Contractor)CMS contractors that investigate and address fraud, waste, and abuse in Medicare and Medicaid.
- GlossaryRAC Audit TriggerDocumentation or coding pattern that increases the likelihood of a Recovery Audit Contractor review.
- GlossaryAudit DefenseThe organized process of preparing for and responding to a payer or government audit.
- GlossaryExtrapolationThe statistical projection of overpayment findings from a sample of claims to a larger universe of claims, used in many Medicare audits.
- GlossaryPost-Payment ReviewPayer review of paid claims after the fact, often resulting in overpayment determinations and recoupment.
- BillingHow to Appeal an Insurance Denial: Step-by-Step GuideClaim denied? Step-by-step appeal process with payer deadlines, denial code fixes, appeal letter template, and escalation options.
This glossary entry is a research aid for billing and compliance staff. It does not provide legal, medical, or financial advice and does not replace counsel. References cited link to primary sources at HHS, OCR, CMS, eCFR, NIST, and the relevant payer or industry body.