Update on Region C RAC Activity: Connolly posts issues for Florida: Issues differ between Region C states
Connolly Healthcare, the RAC for region C, has now posted issues for review in Florida, including one issue not yet approved for other locations.
Similar to South Carolina, RACs may now audit providers in Florida on the following six issues:
- Untimed codes
- IV hydration therapy
- Once in a lifetime procedures
- Pediatric codes exceeding age parameters
- J2505: Injection, Pegfilgrastim, 6 mg
- Blood transfusion
Note that CMS has not approved bronchoscopy services audits at this time for Florida providers.
However, CMS has approved the following new issue:
-
Clinical social worker (CSW) services. CSW services rendered during an inpatient hospital stay are not separately payable under Medicare Part B; they are included in the facility’s prospective payment system (PPS) payment. CSW providers are expected to seek reimbursement from the facility.
Connolly has not yet posted approved issues for other states and territories in the region, including Alabama, Arkansas, Georgia, Louisiana, Mississippi, North Carolina, New Mexico, Oklahoma, Tennessee, Texas, West Virginia, as well as Puerto Rico and the U.S. Virgin Islands.
Stay tuned to the Revenue Cycle Institute blog for daily updates on CMS-approved issues and other RAC news.
Get blog updates in your e-mail
Subscribe to our free Recovery Auditor Report e-zine
Just sent the following e-mail to RAC@cms.hhs.gov and valeria.allen@cms.hhs.gov
I don’t have the time to pursue this but maybe someone at your group might like to. If you can get a definitive response, let me know at Edward.Gross@context4healthcare.com If I get a response, I’ll let you know.
“I would like to point out an inconsistency between the approved RAC IV Hydration audit issue which states that CPT code 96360 (formerly 90760) should have a maximum number of units of 1 while the CMS MUE (Medically Unlikely Edits) value for these same codes is 2.
I’m aware that inquiries regarding MUE (Medically Unlikely Edits) values get mailed/faxed to the National Correct Coding Initiative contractor address; however, I am not questioning this value nor the content/value in this RAC issue. If you feel this is an issue, please feel free to bring it to whomever would be appropriate.”