Revenue Cycle

CMS issues latest quarterly provider compliance newsletter

Recovery Auditor Report, May 5, 2011

CMS and the Medicare Learning Network (MLN) released the third Medicare Quarterly Provider Compliance Newsletter, which offers providers guidance on avoiding common Medicare billing and general errors.

This issue is designed to help fee-for-service providers, suppliers, and their billing staff understand claims submission problems and how to avoid certain billing errors and other improper activities, according to CMS. The newsletter describes the problem, the issues that may occur as a result, the steps CMS has taken to make providers aware of the problem, and guidance on what providers need to do to avoid the problem.

CMS identified recovery audit findings and offers guidance for the following issues: (Provider types affected in parentheses):

  • Incorrect discharge status code inpatient rehabilitation facility overpayment (Inpatient rehabilitation facilities)
  • Incorrect patient status code inpatient rehabilitation facility (IRF) – underpayment (Inpatient rehabilitation facilities)
  • Coagulation disorders–improper coding of MS-DRG 813 coagulation disorders (Inpatient hospital)
  • Human immunodeficiency virus (HIV) disease – wrong diagnosis code or wrong principal diagnosis code billed (Inpatient hospital)
  • Oxaliplatin–dose vs. billed units (Outpatient hospital)
  • Extensive OR procedure unrelated to principal diagnosis DRG 468 MS-DRG 981,982,983 (Inpatient hospital)
  • Untimed Codes—excessive units (Physician, non-physician practitioners and outpatient hospital)
  • Technical component of radiology (Radiology suppliers, physician, and non-physician practitioners)

To view this newsletter, click here.

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