RACs Post New Issues

HealthDataInsights (HDI) posted on their website 66 new approved issues for review in just the first week of 2010. These latest issues all pertain to Medicare Severity Diagnosis Related Group (MS-DRG) coding and DRG validation.

HDI’s list of new issues now includes approximately 70 percent of all MS-DRGs (530 out of 747), which represent both medical and surgical cases. Other new issues HDI, RAC for several Western states (Region D), has posted in the past month or so include those for:

Anesthesia and Pain Management CANPC

  • Parenteral/enteral nutrition (PEN) supply codes. These codes should be reported no more than once a day.
  • Infusion pump denials. When an infusion pump is denied, the infusion accessories and drugs should also be denied.
  • Durable medical equipment, prosthetics, orthotics, and supply (DMEPOS) claims for Part A inpatient hospital stays. Medicare does not make separate payment for DMEPOS while a Medicare beneficiary is an inpatient.
  • Global vs. TC/PC. Providers reimbursed for global procedures should not also be reimbursed for technical modifier TC Technical component and/or professional modifier 26 Professional component for the same service.
  • Facility vs. non-facility payment. Because professional fees vary depending on whether services were provided in a facility or non-facility setting, place of service (POS) should be appropriately indicated on claims.
  • Skilled nursing facility (SNF) consolidated billing. Payment for most SNF services are bundled into the Medicare Part A Prospective Payment System (PPS) and are not paid separately under Part B.
  • Excessive units for A4221. HCPCS Level II code A4221 Supplies for maintenance of drug infusion catheter, per week (list drug separately) should not be reported more than once a week.
  • Prosthetic bundling. Refer to Local Coverage Determination (LCD) L11453 for global billing guidelines.
  • Anesthesia care package. Under National Correct Coding Initiative  (CCI) edit rules, anesthesia CPT® codes 00100-01999 (except 01996) include general evaluation and management (E/M) services rendered on the day before anesthesia, the day of, and all post-operative days. CPT® 01996 Daily hospital management of epidural or subarachnoid continuous drug administration includes E/M services on the same day as the anesthesia service only. An appropriate modifier should be used to indicate an unrelated E/M service provided during the global days of these codes.

Connolly Healthcare, RAC for most of the Southern states (Region C), also posted over 40 new issues on their website recently. These latest issues, approved by the Centers for Medicare & Medicaid Services (CMS), pertain mainly to MS-DRG coding and DRG validation, as well.

DCS Healthcare, RAC for most Northeastern states (Region A), posted on their website six additional issues for DME suppliers, plus one issue for clinical social work providers, and one for ambulance providers.

Meanwhile, CGI Federal’s list of approved issues for Region B states (Minnesota, Wisconsin, Illinois, Indiana, Kentucky, Ohio, and Michigan) remains unchanged since October 2009.


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