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Critical access hospitals (CAH) have received a reprieve of sorts from CMS.
CMS will not evaluate or enforce the “direct supervision” requirement for therapeutic services furnished in calendar year 2010 to outpatients in CAHs, according to a March 15 agency notice to Congress.
“This is good news for CAHs in 2010,” says Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc. “This has already proven to be a significant challenge for some rural hospitals that do not have the medical staff available to provide a 24/7 level of supervision outside of the ER physicians.”
Continue reading about CMS’ decision on the HCPro Web site.
CMS has published a useful chart detailing provider options for RAC overpayment determinations.
To access this chart, click here.
CGI has updated an existing RAC issue for all Region B states, according to the CGI Web site.
The updated issue is as follows:
- Tracheostomy MS-DRG Validation. Previously included only 004,011,012,013 – but has been updated to include 003 DRG, which had been removed when the separate overpayment and underpayment issues were combined into one.
To stay on top of the latest RAC-approved issues in your state, visit the “Tools” Section of the Revenue Cycle Institute Web site and download the updated chart at the top of the page.
CMS has posted the following frequently asked question:
What is the difference between the Recovery Audit Contractor (RAC) discussion period and the Rebuttal and Redetermination process?
CGI, the RAC for Region B, has added 11 new issues for non-medical necessity DRG-validation inpatient claims to its CMS-approved list for providers in all Region B states. According to the CGI Web site, the new issues are as follows:
- Cholecystectomy MS-DRGs 411-419. The purpose of MS-DRG validation is to determine that the principal diagnosis, procedures and all secondary diagnoses identified as CCs and MCCs are actually present, correctly sequenced, and coded. When a patient is admitted to the hospital, the condition established after study found to be chiefly responsible for occasioning the admission to the hospital should be sequenced as the principal diagnosis. The other diagnosis identified should represent all (MCC/CC) present during the admission that impact the stay. The POA indicator for all diagnoses reported must be coded correctly. Reviewers will validate for MS-DRG 411-419 principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG.
- Coronary bypass procedures MS-DRG 234, 236. The purpose of MS-DRG validation is to determine that the principal diagnosis, procedures and all secondary diagnoses identified as CCs and MCCs are actually present, correctly sequenced, and coded. When a patient is admitted to the hospital, the condition established after study found to be chiefly responsible for occasioning the admission to the hospital should be sequenced as the principal diagnosis. The other diagnosis identified should represent all (MCC/CC) present during the admission that impact the stay. The POA indicator for all diagnoses reported must be coded correctly. Reviewers will validate for MS-DRG 234, 236 principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Read More→
CGI, the RAC for Region B, has a new issue for non-medical necessity DRG-validation inpatient claims to its CMS-approved list for providers in all Region B states. According to the CGI Web site, the new issue is as follows:
- Heart Transplant DRG 103 MSDRG 002. The purpose of MS-DRG validation is to determine that the principal diagnosis, procedures and all secondary diagnoses identified as CCs and MCCs are actually present, correctly sequenced, and coded. When a patient is admitted to the hospital, the condition established after study found to be chiefly responsible for occasioning the admission to the hospital should be sequenced as the principal diagnosis. The other diagnosis identified should represent all (MCC/CC) present during the admission that impact the stay. The POA indicator for all diagnoses reported must be coded correctly. Reviewers will validate for MS DRG 002 principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG.
To stay on top of the latest RAC-approved issues in your state, visit the “Tools” Section of the Revenue Cycle Institute Web site and download the updated chart at the top of the page.
Although many providers have tried to curb undercoding over the years, the flurry of activity from Recovery Audit Contractors (RAC) during the last few months has contributed to a proliferation of coding inaccuracies of this nature.
“There’s been a general tendency to undercode at some facilities for a while now. I just think it has gotten worse with fear of RAC audits,” says Kimberly Anderwood Hoy, JD, CPC, director of Medicare and compliance for HCPro, Inc., in Marblehead, MA. “That’s not what CMS intends. They intend for us to be reimbursed correctly for what we do.” Read More→
Earlier this year, two of the four RACs added Medically Unlikely Edits (MUE) to their list of CMS-approved issues. The approval of these issues now gives RACs a new set of issues to study, which includes physician services.
MUEs are units of service edits for HCPCS codes when a single provider / supplier render the services to a single beneficiary on the same date of service, according to CMS. Physicians are affected by the approval of MUEs by CMS.
While physician services have not been the target of RACs since early in the demonstration project, the approval of MUEs by Connolly and HDI puts them back on the RAC radar. (Editor’s note: CGI had approved the issue as well, but has since removed it.) Read More→
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