Updated on: June 22, 2012

Medical Necessity Has Arrived

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Original story posted on: August 13, 2010

cengle120x

As reported in the Aug. 12 AHA News Now Daily Report, CGI Technologies and Solutions Inc., the Region B RAC contractor, has issued a list of the 18 medical necessity reviews that were recently approved for audit by The Centers for Medicare & Medicaid Services (CMS).


This is the first list of medical necessity-specific audits to be announced since the Aug. 10 report that CMS's New Issue Review Board approved as the first "medical necessity review" audits for RACs to begin posting to their respective websites.

 

As of today, the CGI RAC website lists six of the 18 issues, with an Aug. 6 approval date:

 

Issue Name

Issue Type

Claim Types

States

Date Approved

Atherosclerosis w MCC MS-DRG 302 (Medical Necessity Review and MS-DRG Validation)

Complex

Inpatient

IL, IN, KY, MI, MN, OH, WI

8/6/2010

Chest Pain MS-DRG 313 (Medical Necessity Review and MS-DRG Validation)

Complex

Inpatient

IL, IN, KY, MI, MN, OH, WI

8/6/2010

Other Circulatory System Diagnoses w MCC MS-DRG 314, 315, 316 (Medical Necessity Review and MS-DRG Validation)

Complex

Inpatient

IL, IN, KY, MI, MN, OH, WI

8/6/2010

Other Vascular Procedures w CC, w/o CC/MCC MS-DRG 253, 254 (Medical Necessity Review and MS-DRG Validation)

Complex

Inpatient

IL, IN, KY, MI, MN, OH, WI

8/6/2010

Red Blood Cell Disorders w MCC MS-DRG 811 (Medical Necessity Review and MS-DRG Validation)

Complex

Inpatient

IL, IN, KY, MI, MN, OH, WI

8/6/2010

Syncope & Collapse MS-DRG 312 (Medical Necessity Review and MS-DRG Validation)

Complex

Inpatient

IL, IN, KY, MI, MN, OH, WI

8/6/2010

 

So far, the other three RAC auditors have yet to post any approved issues to their sites.

 

AHA: http://www.aha.org/aha/content/2010/pdf/100813-new-issue-racb.pdf

 

CGI: http://racb.cgi.com/Issues.aspx

 

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