Health Information Management

Healthcare News: Take note of the latest RAC developments for regions D and B

JustCoding News: Inpatient, October 28, 2009

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HealthDataInsights (HDI) announced earlier this month two new issues for region D. HDI can now audit DME providers in all region D states for the following two issues:

  • Urological bundling: A potential vulnerability may exist if certain urological procedure codes are billed in conjunction with other urological procedure codes for the same date of service and same beneficiary.
  • Wheelchair bundling: Bundling guidelines for wheelchair bases and options/accessories indicate certain procedure codes are part of other procedure codes and, as a result, are not separately payable.

Access the HDI Web site to learn more about these and other issues for review that CMS has already approved.

CGI, the RAC for Region B, also posted earlier this month three new issues for review in Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio and Wisconsin. The new issues approved for physician and outpatient hospital claim review in these states are:

  • Neulasta: HCPCS code J2505 represents 6 mg per unit. The code should be billed one unit per patient per date of service.
  • ‘Once in a lifetime’ procedures: Specified procedures that can only be performed once in a lifetime per beneficiary.
  • Untimed codes: CPT codes (excluding modifiers -KX and -59) when the procedure is not defined by a specific timeframe (untimed codes), the provider should enter a one in the units billed column per date of service.

Access the CGI Web site to learn more about these and other already approved issues for review.

Note: The Revenue Cycle Institute posts the latest RAC issues for each state on its “Tools” Web page. Simply click the link at the top of the page to download a chart of RAC activity in your state.

In other RAC-related news, CMS has planned a town hall meeting for November 5 from 1-3:30 p.m. Eastern Time to discuss appeals of Medicare payment denials under Section 935 of the Medicare Modernization Act. To pre-register for the conference call, e-mail

Editor’s note: This article was adapted from the Revenue Cycle Institute blog. For more on RACs, visit the CMS RAC Web site. In addition, RAC outreach and informational events are still occurring in many areas. View the latest schedule of events here. Finally, click here for more information from CMS regarding when various types of RAC audits may arrive in your area.

Access a recent article to learn more about other recent RAC developments.

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