Recent RAC Activity
Recovery Auditor Report, April 15, 2010
CGI adds two new issues for medically unlikely edits (outpatient and professional)
- Previous description: An improper payment occurs when two separate acute hospital claims are paid for a Medicare beneficiary who is discharged and re-admitted on the same day and for the same DRG and there is no B4 condition code on the second claim
- New description: An improper payment occurs when two separate acute hospital claims are paid for a Medicare beneficiary who is discharged and re-admitted on the same day and for the same DRG and there are no B4 or 42 condition codes on the second claim.
Stay on top of these issues by visiting the HDI Web Site.
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