2.12.10 – Region B and D Medicare RACs Post New Audit Issues

CGI, the Medicare recovery audit contractor (RAC) for Region B, recently added a new CMS approved audit issue for RAC review pertaining to inpatient claims and MS-DRG validation. The new issue is titled Spinal Procedures Neurostimulators W CC or MCC and it applies to all states within Region B. Region B includes the states of Minnesota, Wisconsin, Michigan, Illinois, Indiana, Ohio and Kentucky.

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.  The following issues were added to the list:

• OP Services Within 72 Hrs of Admit (Part A Outpatient)
• Acute Readmissions – No B4 (Part A Inpatient)
• Incorrect Patient Status – IRF (Part A Inpatient Rehabilitation Hospitals)
• Medically Unlikely Edits (Part A Outpatient, Part B, DME)

The above issues 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.