CMS issues latest quarterly provider compliance newsletter
HIM Connection, May 10, 2011
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CMS and the Medicare Learning Network (MLN) released the third Medicare Quarterly Provider Compliance Newsletter earlier this month. In the issue CMS identified recovery audit findings and offers guidance for the following issues: (Provider types affected in parentheses):
- Incorrect discharge status code overpayment (Inpatient rehabilitation facility [IRF])
- Incorrect patient status code (IRF)
- Coagulation disorders—improper coding of MS-DRG 813 (Hospital inpatient)
- HIV—wrong diagnosis code or wrong principal diagnosis code billed (Hospital inpatient)
- Oxaliplatin—dose vs. billed units (Hospital outpatient)
- Extensive operating room procedure unrelated to principal diagnosis DRG 468 MS-DRG 981,982,983 (Hospital inpatient)
- Untimed Codes—excessive units (Physician, nonphysician practitioners, and outpatient hospital)
- Technical component of radiology (Radiology suppliers, physician, and nonphysician practitioners)
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