CMS Provider Compliance Group To Address OIG and RAC Issues: August 23-25,2011
CMS announced a series of calls on specific Medicare program vulnerabilities identified in HHS Office of Inspector General (OIG) reports. Some of the issues being addressed on the calls correspond to some recently posted RAC Approved Issues. Since CMS has included specific emails for sending in questions before the sessions, provider may wish to compose and send off questions about these issues. The issues listed by CMS are vague enough as to allow for quite a broad range of questions, particularly for the Day Two topics. Find a complete PDF of topics, dates and times below. Continue reading
CMS Region A RAC Adds Three New Issues
The CMS Region A RAC, DCS, added three(3) new approved review issues on August 1, 2011. One issue is an automated review issue for NCCI Edits. The other two issues cover APR-DRGs for the state of Maryland only. RAC Shadow’s lists includes both the relevant codes in the issue titles, for sorting and searching convenience. Continue reading
CMS Region A RAC Edits APR-DRG Issues
The Region A RAC, DCS, edited four (4) previously posted complex review issues for Medical Necessity Review, on July 27, 2011, removing the APR-DRG code numbers and replacing them with equivalent codes for MSDRGs. RAC Shadow’s lists includes both the relevant codes in the issue titles, for sorting and searching convenience. Continue reading
Region A RAC Adds 766 DME Items to Approved Issues List
All 766 HCPCS Codes Included in One New Issue
The Region A RAC, DCS, added a single new automated review issue covering codes for 766 DMEPOS items, yesterday, July 21. The issue involves billing dates for DMEPOS items delivered or fitted for a patient before the actual date of discharge from the hospital or nursing facility. Continue reading
June Approved Issues: Mostly DCS, Medical Necessity Reviews
Medical Necessity Review issues for 11 MS-DRGs and the first two APR DRGs were approved by CMS for the RAC in Region A, during the month of June, 2011. Also, one new Automated Review issue was approved for E&M services including Allergy services, for the Region C RAC. Continue reading