Health Information Management

Healthcare News: CMS posts January issue of provider compliance newsletter

JustCoding News: Inpatient, February 1, 2012

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The January issue of Medicare Quarterly Provider Compliance Newsletter (volume 2, issue 2) addressed a number of recovery audit findings.

The newsletter highlighted the following topics:

  • Ambulance services separately payable during an inpatient hospital stay
  • Billing for Arformoterol (Brovana® [J7605]) and Formoteral fumarate (Perforomist® [Q4099])
  • Diseases and disorders of the circulatory system
  • Lower limb suction valve prosthesis
  • Minor surgery and other treatment billed as inpatient stay
  • Respiratory system DRG 076; MS-DRGs 166, 167, 177, 178, and 179
  • Chronic obstructive pulmonary disease MS-DRG 190, 191, and 192 (medical necessity review and MS-DRG validation)—inappropriate and insufficient documentation
  • Overutilization of positive airway pressure and respiratory assist device accessories—improperly billed quantities

CMS intends for the quarterly newsletter to provide education on how to avoid common billing errors and other erroneous activities when dealing with the Medicare program. You may access previously issued newsletters on the CMS website.



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