NCDs, LCDs and HBO
A funny thing happened on the way to an appeal today. When I educate providers on researching LCDs for Medicare appeals, I always recommend accessing the LCDs through the CMS Coverage Database https://www.cms.gov/medicare-coverage-database/overview-and-quick-search.aspx rather than through the FI or MAC website because I have often found that the LCDs…
CMS Posts Latest RAC Recovery Dollars
CMS has posted on their website an update of overpayments and underpayments thus far (through March 2011) from the RAC program. The publication is titled 2011 FFS Newlestter. It’s interesting that the overpayments collected for the first three months of 2011 is more than double what was collected during the last three…
CMS Revises Redetermination and Reconsideration Appeals Forms
Did anyone notice that CMS has revised thier Redetermination
and Reconsideration Appeals forms? One of my contacts notified me of
this (thank you Robin at PRMC), but the revised forms that were
updated 12/2010 are not listed on the Forms page of the CMS website
(http://www.cms.gov/CMSForms/CMSForms/list.asp#TopOfPage) or on the
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Data Mining for Recent Audit Issues
One of our client hospital systems recently reported that they have been receiving record requests from the RAC for cases where Procedure Code 96.72 (mechanical ventilation 96+ hours) was billed on a length of stay equal to 4 days. The records are being requested under CGI’s published DRG Validation…
CMS Posts New or Updated FAQs Related to RAC
Last week CMS posted several updates to its Frequently Asked Questions list in regard to the RAC program.
In the ongoing quest to answer the question of whether the RAC can audit the same claim multiple times, one FAQ was updated and a new FAQ was posted.
FAQ # 10007, which…
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