Third RAC Posts CMS-Approved Issues

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  • August 28, 2009
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CGI Federal’s first set of approved issues for Recovery Audit Contractor (RAC) review in Region B is now available.

Following HealthDataInsights and Connolly Healthcare’s lead, the approved issues target outpatient hospital and physician claims and include blood transfusions, IV hydration, and bronchoscopy services.

All three RACs will be looking for overpayments due to excessive units reporting. For blood transfusions, IV hydration, and bronchoscopy services, you should bill a maximum of 1 unit per patient, per date of service.

Look for additional information regarding these RAC-approved issues, including affected codes and policy-related links, on CGI’s Web site.

If audited, a provider has an initial discussion period to present additional information to support the services billed. If the provider does not agree with the decision, then the provider has 120 days from date of the First Demand Letter to file an appeal of the determination.

On Oct. 6, 2008, the Centers for Medicare & Medicaid Services (CMS) announced that CGI Technologies and Solutions, Inc. of Fairfax, Va., was awarded Region B, initially working in Indiana, Michigan and Minnesota and later adding Illinois, Kentucky, Ohio and Wisconsin.

CGI may be contacted by phone at (877) 316-7222 and by e-mail at

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