Region B recovery auditor (RAC) CGI Federal has joined its colleagues in regions A and C in posting complex review topics for home health agencies.
 
CGI Federal will examine the medical necessity of both skilled and unskilled services. The two issues posted by the RAC appear identical to those Performant Recovery announced last month. However, CGI Federal provides slightly more detail on one of the review issues, clarifying what it will take for claims to be caught in the review.
 
For the issue "No Skilled Service," "[c]laims with no skilled service billed will be reviewed to determine whether the qualifying criteria of having an ongoing skilled service has been met," CGI Federal says. The second issue reviewed by both MACs will examine nursing services for patients in their third or later episode to determine whether Medicare coverage criteria are met.
 
Region C RAC Connolly, meanwhile, has already begun work on its own complex review topic, which also examines whether medical necessity and other coverage criteria were met.
 
This means that only agencies in region D (Alaska, Arizona, California, Hawaii, Iowa, Idaho, Kansas, Missouri, Montana, North Dakota, Nebraska, Nevada, Oregon, South Dakota, Utah, Washington, Wyoming and outlying territories) remain unaffected by RAC reviews.