HDI, the CMS Recovery Audit Contractor for Region D, posted 20 new issues approved by CMS for Medical Necessity Review , during the first three weeks of August, 2011.
Medical Necessity Review of Uncomplicated Admissions
The Region D RAC, HDI, added two (2) new complex review issues for Medical Necessity Review, today, although the issues are posted as approved on July 7, almost three (3) weeks ago. RAC Shadow’s lists include the relevant codes in the issue titles for easy searching and sorting. Continue reading
Two Automated, Five Medical Necessity Reviews
The Region D RAC, HDI, added two (2) new automated review issues for drug therapy, codes Q4095, J3488 and J3487, as well as five (5) new issues for Medical Necessity Review, last week. RAC Shadow’s lists include the relavent codes in the issue titles, something HDI typically leaves out of their posted issues. Continue reading
Recovery Audit Contractors (RACs) have identified $592.5 million is improper payments to Medicare providers during the first three quarters of FY2011, October 2009 thru June2011, according to new figures published by The Centers for Medicare and Medicaid Services (CMS) on their public website in a document entitled “July 2011 FFS Update [PDF, 217 KB].” All the improper payments identified were made during a 36-month look-back period, which is the current limit set by CMS for the RACs. Continue reading
By Theresa Flaherty | Originally posted at HME News
FARGO, N.D. – CMS plans to halt automated CPAP audits in Jurisdiction D after learning that its contractor has misinterpreted Medicare policy, AAHomecare reported last week.
Medicare policy requires an approved sleep test for CPAP and supplies. HDI, the recovery audit contractor (RAC) for Noridian Administrative Services, the Jurisdiction D DME MAC, interpreted that to mean that Medicare must pay for the test.
In reality, “it doesn’t matter who pays for the sleep test,” said Kelly Riley, director of The MED Group’s National Respiratory Network, and a member of AAHomecare’s CPAP Task Force.
HDI was demanding recoupment on claims where Medicare didn’t pay for the sleep test. Continue reading