2.19.10 – Region D Medicare Recovery Audit Contractor Posts New Issues for DRG Validation

HealthDataInsights, Inc. (HDI), the Medicare recovery audit contractor (RAC) for Region D, recently posted new CMS approved audit issues for RAC review pertaining to Part A inpatient claims and DRG validation.  According to the HDI website, the issues include:

  • Breast Procedures
  • Cardiovascular (Other)
  • Nose, Mouth & Throat Disorders
  • Endocrine, Nutritional & Metabolic Procedures
  • Eye Disorders
  • Female Reproductive System Disorders
  • HIV Infections
  • Infection (Other)
  • Joint Procedures
  • Male Reproductive System Disorders
  • Musculoskeletal Disorders
  • Musculoskeletal Fractures
  • Skin Disorders
  • Disorders Related to Injuries (Toxicity)

The 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.

The issues also include a statement that medical necessity is excluded from review at this time.