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July 20-27 Issuances: CMS posts NCD, OIG issues reports, ICD-9-CM errata available
CMS posts NCD for sleep testing for obstructive sleep apnea (OSA)
On July 21, CMS posted an NCD for sleep testing for OSA.
OIG issues audit reports on Epogen
The OIG released several audit reports on Epogen payments to various facilities of Fresenius Medical Care. The OIG found that claims errors occurred because staff responsible for documenting and flagging the patients’ files for changes in ordered Epogen amounts did not always follow the policy and procedures in the Fresenius Manual for ensuring that changes in the units of Epogen ordered were properly identified and entered into the Fresenius System. The OIG determined that these errors resulted in overpayments.
ICD-9-CM errata
The errata to the ICD-9-CM index and tabular addenda are now available.
Frequently asked questions
CMS posted several new/updated FAQs.
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Frequently asked questions
CMS issued several new/updated frequently asked questions (FAQ).
ICD-9-CM October 2009 update available
The fiscal year 2010 ICD-9-CM index to diseases addenda, tabular addenda, and new code conversion table are now available. These are effective October 1, 2009.
View the ICD-9-CM index to diseases addenda.
View the ICD-9-CM tabular addenda.
View the ICD-9-CM new code conversion table.
Frequently asked questions
CMS issued several new/updated frequently asked questions (FAQ) last week.
While none of the newest RAC FAQ released by CMS-it published 15 in the last week-are particularly surprising, they are perhaps a sign that CMS is continuing to make every effort to share RAC information providers need to know through as many channels as possible.
It may be sharing the same information during RAC outreach sessions or during Open Door Forum calls, but now the information is also readily available to those who wish to learn about RACs in a Q&A format.
The new or updated questions include the following:
- What is the reimbursement procedure and rate for photocopy charges associated with records for RAC audits?
- How will the RACs determine which claims to review?
- Whose claims will be reviewed under the RAC program?
- Under what circumstances can a RAC, make a finding that an overpayment or underpayment exists without requesting medical records?
- Under what circumstances will a RAC request medical records in order to determine if an overpayment exists?
- How long does a provider have to submit medical records when requested by a RAC?
- Do RACs look for underpayments? What happens if they find an underpaid claim?
- How are the RACs paid for finding underpayments?
- If a provider repays or Medicare recoups an alleged overpayment identified by the RAC and the provider later wins an appeal, will CMS reimburse the provider with interest?
- Will the RAC review evaluation and management services on outpatient hospital claims?
- Will the RACs replace all current review entities?
- Will the timing for appeals by the Medicare contractors be the same for the RACs?
- How are the RACs paid for finding and recovering overpayments?
- Will the RAC appeal process mirror the regular Medicare appeal process?
- How will the RACs choose the healthcare entity that is to be reviewed for over- or underpayments? Will it be a random process?
The entire list of questions is available on the CMS Web site.
If you have a RAC question for CMS you have yet to have resolved, perhaps now is a good time to send in your question--CMS may just be in the mood to answer 15 more questions this week.
- Region A: Diversified Collection Services, Inc., www.dcsrac.com
- Region B: CGI, http://racb.cgi.com
- Region C: Connolly Consulting, Inc., www.connollyhealthcare.com/RAC
- Region D: HealthDataInsights, Inc., www.healthdatainsights.com/RecoveryAuditContractor.aspx
April 6-13 Issuances: OIG issues reviews of high-dollar claims, CMS updates FAQs
OIG reviews high-dollar payments for Medicare outpatient claims processed by TriSpan for the period January 1 through December 31, 2004
On April 9, the OIG released a review of high-dollar payments for Medicare outpatient claims processed in 2004 by TriSpan Health Services, a Medicare fiscal intermediary. Of the 16 payments of $50,000 or more that TriSpan made to providers for outpatient services during 2004, the OIG found that only one was appropriate. TriSpan overpaid two providers $767,000 on 15 claims.
OIG reviews of high-dollar payments for inpatient services processed by NGS in certain states for calendar years 2004 through 2006
On April 6, the OIG released a review of high-dollar payments for inpatient services processed from 2004–2006 by National Government Services (NGS), a Medicare fiscal intermediary, in Illinois, Indiana, Kentucky, and Ohio. The OIG found that of the 303 high-dollar payments NGS made to hospitals for inpatient services during these years, 39 were appropriate. The remaining 264 payments included net overpayments totaling $7.4 million.
Frequently asked questions
CMS released several new/updated frequently asked (FAQ) questions last week related to Medicare fee-for-service payment.
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