RACs Update CMS-Approved Audit Issues
Connolly Healthcare, recovery audit contractor (RAC) for region C, recently updated its list of audit issues approved by the Centers for Medicare & Medicaid Services (CMS) and DCS Healthcare, region A RAC, posted new issues for the first time. The lists of issues under review give providers insight into what they should be looking for in their own internal audits.
Connolly Healthcare lists on its Web site the following new audit issues, which directly affect durable medical equipment (DME) suppliers who submit claims to DME Medicare Administrative Contractor (MAC) CIGNA Government Services (CGS) in jurisdiction C:
Wheelchair Bundling – Bundling guidelines for wheelchair bases and options/accessories indicate certain procedure codes are part of other procedure codes and, as a result, are not separately payable. DME suppliers should review claims with dates of services on or after Oct. 1, 2007. See the CGS policy article for wheelchair options/accessories for payment rules.
Urological Bundling – Certain procedure codes are part of other procedure codes and are not separately payable. Specifically, Connolly will be looking at claims for extension tubing (A4331 Extension drainage tubing, any type, any length, with connector/adapter, for use with urinary leg bag or urostomy pouch, each) for use with a latex urinary leg bag. This code is included in the allowance for codes A4314, A4315, A4316, A4354, A4357, A4358, and A5105 and should not be billed separately with these codes. DME suppliers should review claims with dates of services on or after Oct. 1, 2007. See the CGS urological supplies policy article for payment rules.
Clinical Social Worker (CSW) Services – CSW services rendered during an inpatient hospital stay are not separately payable under Medicare Part B; they are included in the facility’s prospective payment system (PPS) payment. CSW providers are expected to seek reimbursement from the facility for dates of service on or after Oct. 1, 2007.
In August, Connolly Healthcare posted the following CMS-approved audit issues:
Blood Transfusions, Untimed Codes, IV Hydration Therapy, Once in a Lifetime Procedures, Pediatric Codes Exceeding Age Parameters, Neulasta, and Bronchoscopy Services.
Following in Connolly’s footsteps, DCS Healthcare’s list of new issues includes wheelchair and urological bundling. DCS also lists the following issue under review:
Pharmacy Supply and Dispensing Fees – Pharmacy supplies and dispensing fees when billed by a DME supplier are required to be accompanied with an oral anti-cancer, oral anti-emetic, immunosuppressive drug or inhalation drug. The absence of one of the aforementioned drugs billed on the same date of service or a denial of one of the aforementioned drugs represents an overpayment.
DCS Healthcare’s new issues under review affect DME suppliers who submit claims with dates of service on or after Oct. 1, 2007 to jurisdiction A DME MAC National Heritage Insurance Company (NHIC).
Region D RAC HealthDataInsights (HDI) and region B RAC CGI Federal also posted new issues under review in August, but have not updated their sites as yet with additional issues.