Chart showing the audit scope for different contractors
Effective Jun 26, 2017
Published Jun 26, 2017
Last Reviewed Jun 26, 2017
Change Request 9809 includes the chart below, which lays out the audit scope for different contractors.
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Pre-payment review
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Post-payment review
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Contractor Type
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Medical rec. rev.
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Non-medical rec. rev.
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Automated reviews
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Medical rec. rev.
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Non-medical rec. rev.
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MACs
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Yes
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Yes
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Yes
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Yes
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Yes
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CERT
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No
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No
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No
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Yes
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No
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RACs
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No
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No
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No
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Yes
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No
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SMRC
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No
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No
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No
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Yes
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Yes
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ZPIC/UPIC
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Yes
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No
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No
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Yes
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Yes
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Source: CMS 100-08, Change Request 9809
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