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New issues for RAC Region D
HealthDataInsights (HDI) has announced two new issues for region D. HDI can now audit DME providers in all region D states for the following two issues:
- Urological bundling
- Wheelchair Bundling
For more information on these issues, visit the HDI Web site. As always, the latest RAC issues for each state are posted on the Revenue Cycle Institute ”Tools” Web page. Simply click the link at the top of the page to download a chart of RAC activity in your state.
CMS plans appeals town hall meeting
CMS has planned a town hall meeting for November 5 from 1-3:30 p.m. Eastern Time to discuss appeals of Medicare payment denials under Section 935 of the Medicare Modernization Act. CMS will release more information on the call in the coming weeks. Stay tuned for the latest information.
RACs have begun auditing at this point, and providers in some states may have received their first denial letters this week. But many providers seem to still be waiting, holding their breath, and worrying whether the mail carrier might deliver their first RAC demand letter(s) that day.
However tempting it may be to simply wait, providers can still use this time effectively. Consider the following tips from several RAC experts: Read More→
DCS Healthcare has released its first CMS-approved issues for audits in Region A.
The three issues, including one new issue not yet approved in other RAC regions, are applicable to durable medical equipment (DME) suppliers in Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont.
According to the DCS Web site, the issues include the following: Read More→
At this point, thanks to a three-year demonstration project and a plethora of available information available for providers, the healthcare industry generally knows what providers are up against in terms of RAC audits. Not that they’ll be easy to handle, but there’s a lot of information out there for providers to help them manage the process.
Unfortunately, comparatively few providers seem to know what to expect with Medicaid Integrity Program audits—which have already begun in many areas across the nation—and in many cases, information that could help them is lacking.
Connolly, the RAC for Region C, approved several issues for North Carolina providers on September 10.
The following issues have been approved for outpatient hospitals and physicians in North Carolina:
- Untimed codes
- Once in a lifetime procedures
- Pediatric codes exceeding age parameters
- J2505: Injection, Pegfilgrastim, 6 mg
Connolly may also audit Durable Medical Equipment (DME) providers in North Carolina for Wheelchair bundling and Urological bundling.
Are you looking for help writing your RAC appeal letters? If so, the Revenue Cycle Institute hopes you will find a sample appeal letter outline useful as you combat RAC denials.
Editor’s note: To view the sample tool, which is courtesy of RAC Report Advisory Board member Stacey Levitt, RN, MSN, CPC, director of patient care management at Lenox Hill Hospital in New York City, click on “Tools” at the top of the Revenue Cycle Institute Web site.
On September 1 Connolly, the RAC for Region C, has approved several issues for which it can audit providers in Alabama and Georgia.
The following issues have been approved for outpatient hospitals and physicians in Alabama:
- Blood tranfusions
- Untimed codes
- IV hydration therapy
- Bronchoscopy services
- Pediatric codes exceeding age parameters
The following issues have been approved for outpatient hospitals and physicians in Georgia:
- Blood tranfusions
- Untimed codes
- IV hydration therapy
- Bronchoscopy services
- Once in a lifetime procedures
- J2505: Injection, Pegfilgrastim, 6 mg
As a reminder, Connolly may also audit Durable Medical Equipment (DME) providers in these two states for Wheelchair bundling and Urological bundling.
Connolly, the Region C RAC, has been approved to audit Durable Medical Equipment (DME) providers for two new issues:
- Wheelchair bundling. Bundling guidelines for wheelchair bases and options/accessories indicate certain procedure codes are part of other procedure codes and, as a result, are not separately payable.
- Urological Bundling. Certain procedure codes are part of other procedure codes and are not separately payable.
This applies to the Region C states, including Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, North Carolina, New Mexico, Oklahoma, South Carolina, Tennessee, Texas, Virginia, West Virginia.
For more information, visit the Connolly Web site.
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