Chart showing the audit scope for different contractors
Effective Jun 26, 2017
Published Jun 26, 2017
Last Reviewed Jun 26, 2017
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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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