On April 26, 2012, Corporate Communications at National Government Services, Inc. issued the following statement: “Recently, the Region B Medicare Recovery Audit Contractor (RAC), CGI Federal, announced that ‘Based on a technical error discovered, CGI finds the Rituximab edit, an automated take back, was disallowed in error. Therefore, CGI reverses the original decision on all claims pulled for Rituximab edit as of April 6, 2012. Please disregard any letters you have received up to this date regarding this edit. There is no need to appeal; all have been cancelled.’ The Healthcare Common Procedure Coding System (HCPCS) code for Rituximab is J9310 (Injection, rituximab, 100 mg).
National Government Services, Inc. received notification of this issue from CGI along with a request to adjust all impacted claims. Such corrections require a manual process and are typically worked, based on the “first in; first out” rule. Unfortunately, due to the current large volume of such requests, along with additional unrelated workload, this manual process is taking longer than expect[ed] to complete and issue refunds when applicable. Until the adjustments are complete, providers may experience recoupments taken in error.
National Government Services assures you that the adjustments and refunds, with interest when applicable, will be completed as quickly as possible. Please understand that since this is a known issue that is in the process of being corrected, you do not need to call the Provider Contact Center to request that a ticket be opened. National Government Services, Inc. thanks you for your patience and understanding.” The announcement from CGI Federal can be found at this link: https://racb.cgi.com/default.aspx
If you have questions related to this announcement or the RAC process in general please contact Regan E. Tankersley at rtankersley@hallrender.com or Elizabeth A. Elias at eelias@hallrender.com.
