The Latest News
Medical Coding Billing & Compliance News
compiled by Team eduTrax
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Written by Team eduTrax
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eduTrax News Service - January 21, 2010.
DRG Coding and DRG Validations Approved for All Permanent RACs
The Centers for Medicare & Medicaid Services (CMS) approved all four of their Recovery Audit Contractors (RACs) to begin review of Medicare claims for Complex Review. The specific target areas for review, at this time, include DRG coding and DRG Validation. Medical Neccessity is not yet under review, despite the requirements stated by the Medicare Program Integrity Manual itself. ...
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Written by Team eduTrax
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eduTrax News Service - January 7, 2010.
Region D RAC Posts 530 Issues for Complex Review
530 MS-DRGs Approved for DRG Validation and MS-DRG Coding Review
Health Data Insights (HDI) posted on their website 66 new approved issues for review, late yesterday, January 6. HDI is CMS's Recovery Audit Contractor (RAC) for several states in the western US. The issues posted by HDI are all for MS-DRG coding and DRG validation, but medical necessity is specifically excluded from review, at this time. The list of MS-DRG’s included in the issues represent both medical and surgical cases, and totals 530 of the 747 existing MS-DRGs, or 70% of all DRGs. Taken together, the four RACs are approved for over 570 DRG Validation issues. Click title to read more...
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Written by Team eduTrax
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eduTrax News Service - January 8, 2010.
New Proposed Rule Governs EHR Incentive Programs, Defines 'Meaningful Use'
The Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) issued two new regulations listing the "meaningful use" criteria healthcare providers must meet in order to quality for federal funding of their information technology (IT) projects under the American Recovery and Reinvestment Act of 2009 (ARRA), on December 30, 2009, just under the statute's deadline. ....
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Written by Team eduTrax
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eduTrax News Service - January 5, 2010.
Region C RAC Posts Over 40 Issues, Most for Complex Review
Focus is on DRG Validation and MS-DRG Coding, Not Medical Necessity. Yet.
Connolly Healthcare, the RAC assigned to most of the southern states, posted over 40 new approved issues on their website, during the last week of 2009. The issues mainly focus on MS-DRG coding and DRG validation, and not medical necessity. The list of MS-DRG’s included in the issues represent both medical and surgical cases. Click title to read more...
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Written by Team eduTrax
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eduTrax News Service - December 21, 2009.
Medicare Fraud Strike Force Expands Operations into Brooklyn, Tampa, Baton Rouge
$61 Million in Fraudulent Billing Alleged in Indictments of Thirty Individuals in Miami, Detroit and Brooklyn
HHS and the Department of Justice (DOJ) reported that thirty people were charged in three cities for their alleged roles in schemes to submit more than $61 million in false Medicare claims, as part of the continuing operation of the Medicare Fraud Strike Force. Also, DOJ and HHS announced the expansion of Strike Force operations to Brooklyn, Tampa and Baton Rouge in three new phases of a targeted criminal, civil and administrative effort against fraud in the Medicare program.
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