Posts Tagged: cgi

Region B RAC Adds Review of Inpatient Admit Orders, 95 DRG Validations

Sunday, July 25th, 2010

RAC-LOGO-CGIIn the continuing posting of issues, the RAC contracted for the upper midwestern states, CGI Federal, has now joined Connolly Healthcare in its posting of an issue that can possibly recoup all Medicare Part A charges for an inpatient claim, and still not even touch the dreaded issue of Medical Necessity.

The List

Below are the 15 new issues, posted last week. Follow the links to each one, in the eduTrax RAC New Issue Database®, which can be seen with simple free registration at myedutrax.com.

1 Date of Death-DME
2 Inpatient Admissions without a Physician’s Inpatient Admit Order
3 MSDRG 052, 053, 054, 055, 056, 057, 058, 059, 060, 061, 062, 063, 067, 068, 069, 070, 071, 072, 073, 074, 077, 078, 079, 080, 081, 082, 083, 084, 085, 086, 088, 089, 090, 091, 092, 093, 097, 098, 099, 101, 102: DRG Validation for Nervous System Disorders
4 MSDRG 165: DRG Validation for Major Chest Procedures
5 MSDRG 168: DRG Validation for Other Respiratory System O.R. Procedures
6 MSDRG 175, 176, 180, 181, 182, 183, 184, 185, 186, 187, 188, 192, 196, 197, 198, 199, 200, 201, 202, 203, 204, 205, 206: DRG Validation for Respiratory
7 MSDRG 242, 243, 244: DRG Validation for Permanent Cardiac Pacemaker Implant
8 MSDRG 247, 249, 251: DRG Validation for Percutaneous Cardiovascular Procedures
9 MSDRG 326, 327, 328: DRG Validation for Stomach, Esophageal and Duodenal Procedures
10 MSDRG 371, 372, 373: DRG Validation for Major Gastrointestinal Disorders and Peritoneal Infections
11 MSDRG 405, 406, 407: DRG Validation for Pancreas, Liver and Shunt Procedures
12 MSDRG 474, 475, 476: DRG Validation for Amputation for Musculoskeletal System and Connective Tissue Disorders
13 MSDRG 490, 491: DRG Validation for Spinal Fusion
14 MSDRG 533, 534, 537, 538, 562, 563: DRG Validation for Musculoskeletal Fractures
15 Prosthetic Additions When Billed With Initial Or Preparatory Knee Prosthesis

More to Come

We’ll have more to say about the review of Physician orders, soon…

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Posted in From the road..., Medical Coding News, RAC New Issues Alerts, Uncategorized | No Comments »

Region B RAC Approved for 47 New DRGs

Tuesday, January 26th, 2010

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:

1 MSDRGs 189: Acute Respiratory Failure
2 MSDRGs 222, 224, 226: Cardiac Defib Implant W Cardiac Cath W/O AMI/HF/Shock W MCC
3 MSDRGs 216, 217, 219, 220: Cardiac Valve & Oth Maj Cardiothoracic Procedures w CC or MCC
4 MSDRGs 034, 035, 037, 038: Carotid Artery Stent & Extracranial Procedures w CC or MCC
5 MSDRGs 231, 233, 235: Coronary Bypass W PTCA/Cardiac Cath w MCC
6 MSDRGs 131: Cranial/Facial Procedures w CC or MCC
7 MSDRGs 020, 021, 023, 025, 026: Craniotomy, Endovascular and Intracranial Vascular Procedures w CC or MCC
8 MSDRGs 113, 116, 121, 124: Disorders Of The Eye, Infections And Procedures (Orbital And Interocular) w CC or MCC
9 MSDRGs 689: Kidney & Urinary Tract Infections w/MCC
10 MSDRGs 237: Major Cardiovasc Thoracic Aortic Aneurysm Repair Procedures w CC or MCC
11 MSDRGs 163, 164: Major Chest Procedures w CC or MCC
12 MSDRGs 129: Major Head & Neck Procedures w CC or MCC
13 MSDRGs 228, 229: Other Cardiothoracic Procedures w CC or MCC
14 MSDRGs 133: Other Ear, Nose, Mouth & Throat O.R.Procedures w CC or MCC
15 MSDRGs 246, 248, 250: Perc Cardiovasc Proc W Drug-Eluting Or Non Drug Eluting Stent w MCC or 4+ Vessels/Stents
16 MSDRGs 041, 042: Periph/Cranial Nerve & Other Nerv Syst Proc w CC or MCC
17 MSDRGs 028, 029: Spinal Procedures Neurostimulators W CC or MCC
18 MSDRGs 003, 004, 011, 012, 013: Tracheostomy
19 MSDRGs 004, 011, 012, 013: Tracheostomy – Underpayment
20 MSDRGs 031, 032: Ventricular Shunt Procedures W CC or MCC

Find a list of all their posted issues HERE.  (Registration required.)

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Posted in Medical Coding News, RAC New Issues Alerts | 1 Comment »

Ambulance Services Reviews Posted by Another RAC

Monday, January 11th, 2010

A Different Posting to Review Ambulance Services during Inpatient Stays

CGI, Region B RAC for CMS, posted Automated Reviews of Ambulance services, as follows:

Separately Paid Ambulance Service during Inpatient Hospitalization Review — Affects Outpatient & Professionals

The description listed is:

Ambulance transports provided by Hospital-Based Ambulance Providers and Suppliers to beneficiaries who are in an inpatient stay are the responsibility of the inpatient hospital provider with the exception of transports on the day of admission, day of discharge and during a leave of absence from the inpatient facility.

This is a different issue from the one just posted by the Region A RAC. That issue only reviewed claims by Ambulance Service Providers, where this new posting reviews Outpatient and “Professional” claims.

To see the complete list, register and logon to the eduTrax RAC New Issues Tools®.

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Posted in RAC New Issues Alerts | No Comments »

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