RAC reviews to require a human touch; automated review becomes MAC only

Why This Topic Matters

These updates affect how Medicare audit contractors are described and how review activity is organized in CMS guidance. Understanding the current terminology and contractor scope is important for compliance teams, auditors, and billing staff who follow Medicare program integrity policy.

Article Sections

1. Who’s who among Medicare audit contractors

   Introduces the contractor types referenced in the CMS guidance and explains the organizational context for the review framework.

2. Medical record review

   Summarizes the article’s discussion of one category of contractor review activity and where it applies across pre-payment and post-payment settings.

3. Non-medical record review

   Covers another review category described in the CMS update and the contractor groups associated with it.

4. Automated review

   Describes the CMS discussion of automated review and how it is positioned within the updated contractor framework.

5. Pre-payment review / Post-payment review chart

   Presents the article’s summary chart showing the review scope by contractor type across the different review categories.