Double trouble: DRG 312 to be reviewed prepayment and postpayment?
Medicare Update for CAHs, September 5, 2012
Following the announcement of the official start date of prepayment reviews (set to begin August 27), providers in certain areas must now brace for an added twist: DRG 312, syncope and collapse, has been listed for review by more than one auditor, and at more than one point in the payment process.
DRG 312, the first issue approved for prepayment auditing, was also announced by the MAC CIGNA Government Services (CGS) as an issue subject to complex medical review for J15 providers.
Ohio and Kentucky make up the J15 states. Ohio is also one the states in the prepayment review demonstration program. Although CMS stated in a December open door forum that claims subject to prepayment review will be off-limits from future postpayment reviews from MACs and Recovery Auditors, it still remains to be seen how this will be done. This puts providers in a difficult position, according to Nancy Beckley, MS, MBA, CHC, president, Nancy Beckley & Associates, LLC, in Milwaukee, Wis.
“If you’re in Ohio, you could potentially have your records requested by the MAC for a complex medical review or you could have your records referred to the RAC [Recovery Auditor] for a prepayment review,” she says. “This will put providers in a squeeze…the [CGS] error rate for DRG 312 is 79.9%.”
Continue reading on HCPro’s Revenue Cycle Institute.
Related Products
-
Core Skills for Hospital Case Managers:
A guide to fundamental case management responsibilities, Core Skills for Hospital Case Managers serves as a training...
-
The RAC Toolkit for Hospitals and Health Systems
The RAC Toolkit for Hospitals and Health Systems: Manage Responses and Avoid Claims Under the Permanent Program is your...
-
The 2013 Medicare Compliance Forum: Las Vegas, NV
-
Level of Care Determinations for 2014: Las Vegas, NV
Attend the half-day seminar, Outpatient, Observation or Inpatient? Continuing to Walk the Tightrope of Regulatory Guidance...
-
OPPS and IPPS Reimbursement Fundamentals: Las Vegas, NV
Attend OPPS and IPPS Reimbursement Fundamentals, a half-day seminar on October 2nd in Las Vegas. Learn how CMS’ substantial...
Most Popular
- Articles
-
- Use caution when applying modifier -25
- Don't forget the three checks in medication administration
- Nursing responsibilities for managing pain
- Steps for maintaining patient privacy
- Know guidelines and subtle differences in code descriptions for laceration repairs
- Practice the six rights of medication administration
- Poor documentation: The consequences
- Note similarities and differences between HCPCS, CPT® codes
- Complications from immobility by body system
- Q&A: Primary, principal, and secondary diagnoses
- E-mailed
-
- Understand how to apply the 1995 and 1997 Documentation Guidelines for E/M Services
- Tip: Identify covered nerve block procedures
- Putting Management and Evaluation into Perspective
- OB services: Coding inside and outside of the package
- Learning and mastering the operating budget
- CAHs and condition code 44
- 10 Tips for Educating Elderly Patients
- Searched