NEULASTA RAC AUDITS

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  • November 19, 2012

11/19/2012
Medicare Updates
HealthDataInsights (HDI), the Recovery Audit Contractor (RAC) for Region D (AK, AZ, CA, HI, IA, ID, KS, MO, MT, ND, NE, NV, OR, SD, UT, WA, and WY) has been auditing payments for pegfilgrastim (Neulasta) and requesting repayment if this medication was administered on the same day as chemotherapy for claims dating back to 2009.

Several state societies including WA, OR, ID, AZ, CA, UT and AK have been working with Noridian, CMS and ASCO to try to get these audits stopped. Last week, the WA state society was informed that the RAC audits on same day Neulasta have been halted. We are awaiting the publication of an article on the administration of Neulasta on the same day as chemotherapy, and will provide that information as soon as it is available. Nevertheless, it is very important that you continue to respond promptly to all RAC requests you receive and to appeal recoupments when appropriate. I will provide updates on this issue as they are received.