Corporate Compliance

Recent Recovery Auditor activity

Medicare Insider, March 18, 2014

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Connolly posts two new issues in two categories
Connolly posted two new issues in two categories in to its CMS list for providers in Region C. (See link for individual state applicability.)
According to the Connolly website, the new issues are:
For outpatient hospitals:
  • Incorrect Billing of Hydration Therapy - OP - C003932013. Providers are billing hydration therapy with diagnosis codes that are not considered reasonable and medically necessary per applicable LCDs.
 
For physicians:
  • Incorrect Billing of Major Joint Replacement Procedures - Carrier - C004142013. Overpayments were identified where ICD-9 codes billed were not in accordance with billing requirements outlined in Local Coverage Determinations.
 
CGI posts one new issue
 
CGI posted one new issue in one category to its CMS list for providers in Region B. (See link for individual state applicability.)
According to the CGI website, the new issue is:
For professional services:
  • PF Observation Care Billed with Discharge Services on the Same Day – J8 (WPS). An issue exists where discharge services have been reported incorrectly with Observation Services on the same date of service. This automated review will identify the incorrect reporting of discharge services when billed on the same day as an Observation Service for a beneficiary.



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