1.22.10 – Region B and D Medicare RACs Continue to Add CMS Approved Audit Issues
1. HealthDataInsights, Inc. (HDI), the Medicare recovery audit contractor (RAC) for Region D, recently posted new CMS approved audit issues for RAC review on its website.
HDI added 5 new CMS approved audit issues pertaining to Medicare Part B claims, which apply to all states within Region D. Region D includes Alaska, Arizona, California, Hawaii, Iowa, Idaho, Kansas, Missouri, Montana, North Dakota, Nebraska, Nevada, Oregon, South Dakota, Utah, Washington, Wyoming, Guam, American Samoa, and Northern Marianas.
The recent approved issues are:
- Clinical Social Worker (CSW) Services During Inpatient Stay
- NCCI Edits
- Hospice Related Services – B
- TC of Radiology
- Not a New Patient – Providers are only allowed to bill the CPT codes for New Patient visits if the patient has not received any professional services from the physician or physician group practice within the previous 3 years.
For more information refer to the HDI website.
2. CGI, the Medicare recovery audit contractor (RAC) for Region B, recently updated its CMS approved audit issues for RAC review.
Specifically, CGI expanded its CMS approved audit issues for outpatient hospitals and professionals in all Region B states. Region B includes the states of Minnesota, Wisconsin, Michigan, Illinois, Indiana, Ohio and Kentucky.
The recent update to the CMS approved audit issues include:
- Intravenous Infusion Chemotherapy and Non-Chemotherapy – Excessive Units Reported
- Preadmission Testing
- Separately Paid Ambulance Service during Inpatient Hospitalization Review
CGI also added the issue of Hospital to Hospital Transfer for inpatient hospitals.
For more information, refer to the CGI’s website.
