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Medicare RAC Region B Web Site
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Welcome to Medicare RAC Region B.

Region-B Providers:

Requests for medical records for reviews involving Rituximab and Herceptin are in part being submitted without  key pieces of documentation. Requested and required are 1) The Administration Record (including start/stop time), 2) Signed and dated physician order (for Chemotherapy), 3) Infusion (start/stop time) and 4) Drug order including the dose and route. Omitting these documents as part of the supplied medical records will cause the review to result in a Findings due to an Incomplete Medical Record.

 

Please make every attempt to submit all requested documentation provided in the medical records request letter.

Discussion Period

The discussion period offers the opportunity for the provider to submit additional information to the RAC to indicate why recoupment should not be initiated. Discussions may be processed entirely in writing or may require a teleconference with the provider. To request a discussion, please download the Discussion Request Form that can be found on the RACB web site http://racb.cgi.com. This form, along with any additional documentation should be submitted to CGI preferably by fax or by mail as shown on the form.

If you have questions or concerns, please contact us as soon as possible at:

CGI Federal Inc.

1001 Lakeside Avenue, Suite 800

Cleveland, OH 44114

Phone: 877-316-RACB (7222)

Email: RACB@cgi.com

Fax: (216) 687-4278

The Discussion Request form and any additional information must be submitted to CGI within 40 days of the accounts receivable date. After reviewing the additional documentation submitted, the RAC could decide to uphold, overturn, or modify their decision. A letter will be sent to the provider detailing the outcome of the written or oral discussion.

Background on the RAC Program

RAC Permanent Program:

Section 302 of the Tax Relief and Health Care Act of 2006 makes the RAC Program permanent and requires the Secretary to expand the program to all 50 states by no later than 2010.

Implementation Strategy:

By 2010, CMS plans to have 4 RACs in place. Each RAC will be responsible for identifying overpayment and underpayments in approximately ΒΌ of the country. The new RAC jurisdictions match the DME MAC jurisdictions.

The RAC demonstration program has proven to be successful in returning dollars to the Medicare Trust Funds and identifying monies that need to be returned to providers. It has provided CMS with a new mechanism for detecting improper payments made in the past, and has also given CMS a valuable new tool for preventing future payments.

  • Step 1 - Expand the Current RACs: In the Spring of 2007, CMS added one state to each of the current 3 RAC jurisdictions.
  • Step 2 - Full and Open Competition for 4 RAC Jurisdictions: In the Spring of 2007, CMS began the process to procure 4 RAC contractors through a full and open competition. On March 16, 2007 CMS released a Request for Information (RFI) which contained a draft statement of work. On August 16, 2007 CMS released a pre-solicitation notice which contained a statement of work. On October 19, 2007, CMS released a Request for Proposal (RFP) which opened a Question and Answer period. On November 7, 2007, CMS posted a revised Statement of Work. Answers to the questions were posted on November 19, 2007.

Who Was Awarded Region B?

On October 6, 2008, CMS announced that CGI Technologies and Solutions, Inc. of Fairfax, Virginia, was awarded Region B, initially working in Indiana, Michigan and Minnesota. Illinois, Kentucky, Ohio and Wisconsin will be added to RAC Region B in 2009. CGI may be contacted by phone at 877-316-7222 and by e-mail at racb@cgi.com.

© 2009 CGI Federal