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Healthcare News: DCS Healthcare announces approved RAC audit issues in Region A

JustCoding News: Inpatient, September 30, 2009

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On September 21, DCS Healthcare posted 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.

The DCS Web site lists the following approved issues:

• Pharmacy supply and dispensing fees. Pharmacy supply and dispensing fees when billed by a DME supplier are required to be accompanied with an oral anti-cancer, oral anti-emetic, immunosuppressive drug or inhalation drug. The absence of one of the aforementioned drugs billed on the same date of service or a denial of one of the aforementioned drugs represents an overpayment.
• Wheelchair bundling. A potential vulnerability may exist if certain procedure codes are billed in conjunction with other procedure codes for the same date of service and the same beneficiary.
• Urological bundling. A potential vulnerability may exist if certain urological procedure codes are billed in conjunction with other urological procedure codes for the same date of service and same beneficiary.

The DCS Web site also lists several helpful samples and links for providers, including a sample automated review demand letter, a sample complex demand letter, a sample envelope, letterhead, and more.

The RACs from Regions B, C, and D have already posted approved issues for most other states. Access a recent JustCoding story to learn more about these developments. The only states for which CMS has not yet approved issues are those in Region B (i.e., Illinois, Kentucky, Ohio, and Wisconsin).

Editor’s note: This article was adapted from the Revenue Cycle Institute blog. For more on RACs, visit the CMS RAC Web site. In addition, RAC outreach and informational events are still occurring 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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