Health Information Management

Healthcare News: RACs announce additional issues approved for review in North Carolina, Alabama, Georgia, and other states in Regions B and C

JustCoding News: Inpatient, September 16, 2009

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Editor's note: Access a recent JustCoding article to learn more about important RAC developments.

On September 10, Connolly, the RAC for Region C, approved several issues 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

On September 1 Connolly approved several issues for which it can audit outpatient hospitals and physicians in Alabama:

  • Blood transfusions
  • 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 transfusions
  • Untimed codes
  • IV hydration therapy
  • Bronchoscopy services
  • ‘Once in a lifetime’ procedures
  • J2505: Injection, Pegfilgrastim, 6 mg

Connolly previously announced that it had approval to audit durable medical equipment providers for these two 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, and West Virginia.

On August 14, CGI Federal, the RAC for Region B, posted its first set of issues eligible for RAC audits in Indiana, Michigan, and Minnesota.

The approved issues target outpatient hospital and physician claims and correspond with those approved for many states in RAC regions C and D:

  • Blood Transfusions. Blood transfusions should be billed with a maximum of one unit per patient per date of service.
  • IV-hydration. IV-hydration should be billed with a maximum of one unit per patient per date of service.
  • Bronchoscopy Services. Bronchoscopy services should be billed with a maximum of one unit per patient per date of service.

CGI provides additional information about each issue on its Web site, including claim types and codes affected, and whether it is looking for over- and/or underpayments. For these three issues, CGI is looking solely for overpayments.

The CGI Web site also has sample letters, FAQs, and other information providers in the region may find helpful.

Editor’s note: This article was adapted from various articles that originally appeared on the Revenue Cycle Institute blog. For more on RACs, visit the CMS RAC Web site. In addition, RAC outreach and informational events are still going on in many areas. View the latest schedule of events here. Finally, click here for more information from CMS regarding when various types of RAC audits may arrive in your area.



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