Corporate Compliance

Recent Recovery Auditor activity

Medicare Insider, May 6, 2014

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CGI posts two new issues in one category
 
CGI posted two new issues in one category to its CMS list for providers in Region B. (See link for individual state applicability.)
 
According to the CGI website, the new issues are:
 
For outpatient services at Critical Access Hospitals:
 
·         The Cardiovascular Nuclear Medicine services have coverage guidelines specific to the Local Coverage Documentation and the CMS Manuals in Ohio and Kentucky. Decision-making for testing is based upon the presence of multiple clinical risk factors, the level of functional capacity, the risk of the surgery and the likelihood that the results of the cardiac testing would change the management. There are specific diagnoses associated with each form of testing. When an unapproved diagnosis is reported for any type of Cardiovascular Nuclear Medicine service, the service is denied.
 
·         The Cardiovascular Nuclear Medicine services have coverage guidelines specific to the Local Coverage Documentation and the CMS Manuals in Michigan and Indiana. Decision-making for testing is based upon the presence of multiple clinical risk factors, the level of functional capacity, the risk of the surgery and the likelihood that the results of the cardiac testing would change the management. There are specific diagnoses associated with each form of testing. When an unapproved diagnosis is reported for any type of Cardiovascular Nuclear Medicine service, the service is denied.



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