1.8.10 – Region C Medicare Recovery Audit Contractor Adds New CMS Approved Audit Issue

Region C Medicare Recovery Audit Contractor Adds New

CMS Approved Audit Issue

Connolly Healthcare, the Medicare recovery audit contractor (RAC) for Region C, recently posted new CMS approved audit issues for RAC review on its website. Please refer to each approve issue for applicability to your state. Region C includes Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, North Carolina, New Mexico, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, Virginia, Virgin Islands and West Virginia.

The titles for the new CMS approved audit issues are:

APPROVED ISSUE — MS-DRG (if applicable)

1.    Other Kidney and Urinary Tract Procedures with MCC (At this time Medical Necessity excluded from review)  –  673
2.    Wound Debridements for Injuries without CC/MCC (At this time Medical Necessity excluded from review)  –  903
3.    Wound Debridements for Injuries with MCC (At this time Medical Necessity excluded from review)  –  901
4.    Wound Debridements for Injuries with CC (At this time Medical Necessity excluded from review)  –  902
5.    Postoperative or Posttraumatic Infections with O.R. Procedure with MCC (At this time Medical Necessity excluded from review)  –  856
6.    Postoperative or Posttraumatic Infections with O.R. Procedure with CC (At this time, Medical Necessity excluded from review)  –  857
7.    Infectious and Parasitic Diseases with O.R. Procedure with MCC 853 (At this time, Medical Necessity excluded from review)  –  853
8.    Postoperative or Posttraumatic Infections with O.R. Procedure without CC/MCC (At this time Medical Necessity excluded from review)  –  858
9.    Infectious and Parasitic Diseases with O.R. Procedure with CC (At this time Medical Necessity excluded from review)  –  854
10.    Infectious and Parasitic Diseases with O.R. Procedure without CC/MCC (At this time Medical Necessity excluded from review)  –  855
11.    O.R. Procedure with Principal Diagnoses of Mental Illness (At this time Medical Necessity excluded from review)  –  876
12.    Full Thickness Burn with Skin Graft or Inhalation Injury with CC/MCC (At this time Medical Necessity excluded from review)  –  928
13.    Other Kidney and Urinary Tract Procedures with CC (At this time Medical Necessity excluded from review)  –  674
14.    Nonextensive Burns (At this time Medical Necessity excluded from review)  –  935
15.    Peritoneal Adhesiolysis with MCC (At this time, Medical Necessity excluded from review)  –  335
16.    Barium Swallow Studies Units Billed  –  Outpatient service
17.    Adenosine – Dose vs. Units billed  –  Outpatient service
18.    Nebulizer, Demonstration and Evaluation Units Billed  –  Outpatient service

More information on the new CMS approved audit issue for Region C can be found here.