Corporate Compliance

Other Issuances: RACs update audit issues, OIG audits lab billing, and more

Medicare Insider, March 30, 2010

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RACs update audit issues, post demand letter

CGI Federal and HealthDataInsights, the RACs for regions B and D, continue to update their approved audit issues. CGI has also posted a sample of its demand letter for complex issues.

View CGI’s updated issues.

View HDI’s updated issues.

View CGI's complex demand letter.

HHS posts appeals decision

HHS has released an appeals decision related to recoupment of reimbursement for medically unnecessary inpatient stays. Because Part B payment can be made in cases when Part A payment is denied, the Medicare Appeals Council directed the contractor to work with the provider to take whatever actions are necessary to arrange for billing under Part B, and thus offset any Part A overpayment.

View the decision.

OIG audits separately billed lab tests for ESRD beneficiaries

On March 18, the OIG released an audit report on separately billed laboratory tests submitted by Spectra Laboratories for Medicare beneficiaries with end-stage renal disease (ESRD) receiving dialysis at Fresenius Medical Care North America’s facilities. The OIG determined that Medicare overpaid Spectra $5.4 million for separately billed laboratory tests from 2004–2006.

View the OIG report.

Frequently asked questions

CMS has posted several new/updated frequently asked questions (FAQ).

View a list of updated FAQs.



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