US · guidance
CMS Pub. 100-09, ch. 6, § 20.2.1
Improper Payments Data Analysis
MACs shall analyze Recovery Auditors data from the Recovery Audit Contractor (RAC) Data
Warehouse in accordance with the Medicare Access and CHIP Reauthorization Act (MACRA)
2015 section 505. This analysis serves as the foundation for developing targeted educational
interventions that address the most significant sources of improper payments within each MAC’s
jurisdiction.
MACs shall analyze data to identify:
• High Risk Providers – Providers with the highest improper payment rates
• High Dollar Providers – Providers responsible for the greatest total dollar amounts of
improper payments
• High Risk Services - Items and services with the highest improper payment rates
• High Dollar Services - Items and services generating the greatest dollar amounts of
improper payments
• Additional CMS-Specified Data – Other data elements CMS determines necessary for
program improvement
History
(Rev. 13683; Issued: 04-08-26; Effective: 05-08-26; Implementation: 05-08-26)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
5bfd3ea1512635803698c567cea3a0810c08092a3f9e1451b7ee7f73186ff560
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