Revenue Cycle

CMS posts new quarterly provider compliance newsletter

Recovery Auditor Report, January 26, 2012

In its most recent (January 20) Medicare Quarterly Provider Compliance Newsletter, CMS once again provides official guidance on correcting problematic billing errors that it identified during the last quarter.

These releases are designed to help providers, suppliers, and billing staff understand claims submission problems while also providing guidance on how to avoid these errors as well as other improper billing activities in the future.

 CMS identified the following recovery audit findings in the newsletter (affected provider types in parentheses):
  • Ambulance services separately payable during an inpatient hospital stay (Inpatient hospitals, ambulance providers)
  • Billing for Arformoterol (Brovana ®) (J7605) and Formoteral fumarate (Perforomist ®) (Q4099) (Durable medical equipment suppliers)
  • Diseases and disorders of the circulatory system (Inpatient hospitals)
  • Lower limb suction valve prosthesis (Durable medical equipment suppliers)
  • Minor surgery and other treatment billed as inpatient stay (Inpatient hospital)
  • Respiratory system DRG 076, MS-DRGs 166,167, 177, 178, and 179 (Inpatient hospitals)
  • Chronic obstructive pulmonary disease (COPD) MS-DRGs 190, 191, and 192 (Medical necessity review and MS-DRG validation)—Inappropriate and insufficient documentation (Inpatient setting)
  • Overutilization of positive airway pressure (PAP) and respiratory assist device (RAD) accessories—Improperly billed quantities (DMEPOS suppliers)

As has been the case thus far, the bulk of the issues affect inpatient hospitals.

To view the most recent quarterly provider compliance newsletter, click here:


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