Revenue Cycle

CGI posts first approved issues for RAC review in Region B

HCPRO Website, August 26, 2009

Region B, get ready. RACs may begin auditing at any time in several Region B states.
CGI Federal, the RAC for Region B, has posted its first set of issues eligible for RAC audits in Indiana, Michigan, and Minnesota.
The approved issues target outpatient hospital and physician claims and correspond with those approved for many states in RAC regions C and D that were posted over the past few weeks:
  • Blood Transfusions. Blood transfusions should be billed with a maximum of one unit per patient per date of service.
  • IV-Hydration. IV-Hydration should be billed with a maximum of one unit per patient per date of service.
  • Bronchoscopy Services. Bronchoscopy services should be billed with a maximum of one unit per patient per date of service.
CGI provides additional information about each issue on its Web site, including claim types and codes affected, and whether it is looking for over- and/or underpayments. For these three issues, CGI is looking solely for overpayments.
Indiana, Michigan, Minnesota are the three “yellow” region B states where RAC audits were scheduled to begin first. The remaining states in the region, Wisconsin, Illinois, Kentucky, and Ohio, were part of the second wave of “blue” states that were scheduled to begin after August 1.
The CGI Web site also has sample letters, FAQs, and other information providers in the region may find helpful.
Editor’s note: For more on RACs, visit the CMS RAC Web site. In addition, RAC outreach and informational events are still going on in many areas. View the latest schedule of events here. Finally, click here for more information from CMS regarding when various types of RAC audits may begin in your area.

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