Medical Coding News by 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.

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.

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