RAC E/M audit limited to 3 providers, could see widespread expansion next year, CMS says

Why This Topic Matters

It matters because a limited audit can become a broader audit program, affecting documentation review, billing compliance, and recoupment exposure for providers in the affected jurisdiction and potentially elsewhere.

Article Sections

1. E/M billing

   Introduces the CMS recovery audit review focused on evaluation and management claims and explains the limited test-phase nature of the issue. It also frames the potential for broader approval if the review proceeds.

2. More details of the RAC E/M audit

   Describes the status of the limited review, the documentation request process, CMS oversight, and the regional scope of the contractor’s jurisdiction. It also addresses how the issue was published and the context for transparency around the review.