CGI Federal Lists 20 New Issues
Includes 47 DRGs for Overpayment and 4 DRGs for Underpayment
CGI Federal, the RAC for Region B (western states), posted 20 new approved issues for review on their RAC Issues page, on Friday, January 22, 2010. Following the format being used by the Region D RAC, HDI, the listed issues are grouped together by Issue Name, which often includes multiple MS-DRGs.
All of the new issues are approved for DRG Validation, affecting all seven of the Region B states (IL, IN, KY, MI, MN, OH, WI). Notably, one of the new issues posted is approved for underpayment review, although only for four(4) of the five (5) MS-DRGs listed in the issue approved for overpayment review.
None of the new issues mention review of Medical Necessity, although such reviews do not appear to have been approved for any of the RACs, to date. However, it is likely that the existing DRG Validation issues will all be approved for medical necessity review in short order, since the CMS RAC Review Phase-In Strategy allows for such approvals in calendar 2010.
Find links to all the RAC New Issues Pages here. For more useful lists, see below.
Use the links below to see details, in our database:
Find a list of all their posted issues HERE. (Registration required.)
recovery audit contractor
CMS Expands RAC Records Requests Limits
Limits Now Apply to All Institutional Claim Types, Not Just DRG Validations
The Centers for Medicare & Medicaid Services (CMS) modified its FY2010 Additional Documentation Request (ADR) Limits, expanding the scope of the rule to include all institutional providers, on January 28, 2010. Previously, the rule applied to ADRs for DRG Validation issues only, as posted by CMS on December 1, 2009, and would have only applied to Medicare Part A providers. CMS also indicated that more changes are yet to come, with rules applying to physicians and other types of providers, including DME suppliers.
The December posting indicated that there would be two “caps” made on RAC ADRs, during FY2010. Through March 2010, the cap would remain at 200 ADRs per 45 days for all providers/suppliers. However, from April through September 2010, providers/suppliers who bill in excess of 100,000 claims to Medicare, across all claims processing contractors, would have a cap of 300 ADRs per per 45 days.
These limits would apply per “campus” instead of per NPI (National Provider Identifier). The definition of a campus is CMS’s new method of calculating limits, and is based on providers’ Tax ID Numbers plus the first three numbers of the ZIP code where those provider entities are physically located.
This most recent posting does not change any of the previous limits or definitions, but does expand the rule to apply to all claim types, not just DRG Validations.
Read the new document HERE , along with a copy of the text from the December document.
Tags: audits, CMS, complex review, medical billing, medical coding, Medical Coding News, medical documentation, medical records, medical records request limits, medical records review process, medicare, medicare reimbursement, rac approved issues, RAC audits, rac new issues, records review, recovery audit contractors
Posted in From the road..., Medical Coding News | No Comments »