Three Automated Denial Issues Added to RAC’s Site
The RAC for Region B, CGI Federal, has just this afternoon posted three new issues to their “new Issues” page. The three “new issues” approved as of 9/30/2009 are:
- Neulasta (billed more than once per patient per date of service)
- Once in a Lifetime Procedures (billed more than once per patient)
- Untimed Codes (specific codes billed more than one unit per date of service)
See the links above to jump to those pages. The pages now include links to Related Policy Documents.
These issues are approved for all the Region B states: Illinois, Indiana, Kentucky, Michigan, Minnesota, and Ohio.
Differences Begin to Appear
Readers should note that, to date, the CGI approved issues are all only for Outpatient Hospital and Physician claims. Other RACs have been approved for issues in both Part A and Part B claims. For example, two of the new issues have been approved for ALL types of claims for HDI in Region D, while the Neulasta issue is approved for Region D, but only for Part A claims, and with a slightly different billing rule in effect.
Furthermore, the Region C RAC, Connolly Healthcare, was already approved in June for automated review of both the “Untimed Codes” and “Once in a Lifetime” issues, for Outpatient and Physician claims, just like CGI; however, Connolly has not yet posted any approval for review of “Neulasta” claims.
The Region D RAC, HDI, was likewise already approved in June for Outpatient and Physician claims reviews for “Untimed Codes” and “Once in a Lifetime” issues, but they were also approved for “Neulasta” reviews for Part A claims only.
Details, Details
We strongly suggest that readers review these differences on the RAC New Issues pages, which can be easily accessed from the eduTrax website, HERE.
We would also remind readers that all these issues, regardless of when they were “approved” for review, the RACs can and will be reviewing claims including dates of service going back to 10/1/2007.
recovery audit contractorTags: automated denials, rac, RAC audits, recovery audit contractor