Medicare’s new Recovery Audit Contractor (RAC) has announced its list of upcoming DMEPOS (durable medical equipment, prosthetics, orthotics and supplies) audit projects.
The American Association for Homecare (AAHomecare) announced the RAC audit projects in an Oct. 14 bulletin to stakeholders and noted these are the first audit projects by Cotiviti GOV Services, the new RAC.
The RAC will conduct complex reviews — ones for which participating suppliers will receive audit requests and must provide supporting documentation, AAHomecare noted — for oxygen medical necessity and documentation; positive airway pressure (PAP) device medical necessity and documentation; ventilator medical necessity and documentation; and immunosuppressive drug medical necessity and documentation.
Cotiviti GOV Services will also perform an automated review of durable medical equipment (DME) rentals, focusing on multiple billings in the same month (27 days). AAHomecare noted that automated reviews do not require action on the part of providers.
“Cotiviti was awarded the RAC contract for Region 5 in April 2025, becoming the first new Medicare DMEPOS RAC contractor in nearly a decade,” AAHomecare said. “Following the announcement, AAHomecare had an introductory meeting with Cotiviti and CMS’s RAC oversight team to share supplier perspectives and to establish an open line of communication as Cotiviti begins rolling out its contract. During the meeting, Cotiviti emphasized that it intends to take a measured approach to implementation, assuring that it will ramp up audit activities slowly rather than launching widespread reviews immediately.”
The association added it “continues to engage with CMS and Cotiviti” to ensure that providers’ voices are heard as audit projects roll out.
“According to Cotiviti, the five approved DMEPOS audit projects were selected after a data-driven review and approval by CMS,” AAHomecare said. “While Cotiviti has significant experience auditing DMEPOS claims on the Medicaid side, Medicare RAC reviews will introduce new complexities, including distinct coverage rules, medical necessity criteria, and documentation standards.”
