The Latest News
Medical Coding Billing & Compliance News
compiled by Team eduTrax
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The fourth CMS Recovery Audit Contractors (RAC) posted ten new issues including 87 DRG Validations, late on June 23. Medical Necessity is still not approved for review under any of these issues.
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HHS & DOJ Send Letter: Outreach to Combat Medicare Fraud
U.S. Secretary of Health and Human Services Kathleen Sebelius and Attorney General of the United States Eric Holder today sent a letter to state attorneys general urging them to work with HHS and federal, state, and local law enforcement officials to mount a substantial outreach campaign to educate seniors and other Medicare beneficiaries about how to prevent scams and fraud beginning this summer.
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Lack of Appropriate Modifiers Cited
The Centers for Medicare & Medicaid (CMS) approved the RAC for Region D (HDI) on March 31, 2010, for two new issues involving Automated Review of Medicare claims including the use of several specific Modifers for Evaluation and Management (E&M) service codes. HDI posted those news issues on their Approved Issues page on Friday, May 28.
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Clarifies Language in Program Integrity Manual
The Centers for Medicare & Medicaid (CMS) added a new Section (§ 3.14) regarding Clinical Review Judgement to the Medicare Program Integrity Manual. The new Section clarifies existing language regarding clinical review judgments, and also requires that Medicare claim review contractors
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Written by Team eduTrax
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Wednesday, 19 May 2010 00:00 |
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During the May 5, 2010 RAC 101 Conference Call, Scott Wakefield, a CMS RAC Project Manager stated that providers may begin to receive RAC medical necessity reviews “within the next month or so.” According to one observer we spoke to, he seemed somewhat surprised that no such reviews have been posted by the RACs, as yet, and intimated that such issues had already been approved.
Meanwhile, more issues have been posted by all four RACs in the past two weeks. A list of those new issues appears below. All issues for Complex Review still include a statement that medical necessity is excluded from review, at this time.
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Last Updated on Saturday, 22 May 2010 21:15 |
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