Two RACs Add to List of Issues Under Review
Recovery Audit Contractors (RAC) HealthDataInsights (HDI) and CGI Federal have added to their list of new issues eligible for review as per the Centers for Medicare & Medicaid Services (CMS).
The RAC program, mandated by the Tax Relief and Health Care Act of 2006, is being implemented in 2010 to detect and correct past improper Medicare payments.
Tip: Don’t wait until Jan. 1, 2010 to review these new issues and correct any problems your outpatient hospital or physician practice may uncover.
HDI, RAC for region D, recently posted the following new CMS-approved issues on their Web site:
“A potential vulnerability may exist if certain urological procedure codes are billed in conjunction with other urological procedure codes for the same date of service and same beneficiary,” HDI claims.
HDI refers to CMS Pub. 100-03, chap. 1, sec. 230.17, “Urinary Drainage Bag,” and Noridian LCD A25377 for additional information.
“Bundling guidelines for wheelchairs bases and options/accessories indicate certain procedure codes are part of other procedure codes and, as a result, are not separately payable,” according to HDI.
For guidance, refer to CMS Pub. 100-03, chap. 1, sec. 288.1, 280.3.
Knee Orthotic Bundling
“There are knee orthotic addition codes that cannot be billed separately due to the fact that they are bundled with the base knee orthotic codes or that the addition code is not medically necessary when billed in conjunction with a specific knee orthotic base code,” claims HDI.
Meanwhile, CGI Federal (region B RAC)—in keeping with its compatriots—added Neulasta, Once in a Lifetime Procedures, and Untimed Codes to its list of CMS-approved issues for review. Refer to CGI Federal’s Web site for issue details, including policy-related links.