August 19, 2009

RAC Alert

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In a somewhat surprise move Wednesday afternoon Connolly Healthcare, the Region C RAC, posted a new CMS approved issue regarding clinical social work services.  “Clinical Social Worker (CSW) services rendered during an Inpatient Hospital stay are not separately payable under Medicare Part B; they are included in the facility’s Prospective Payment System (PPS) payment. CSW providers are expected to seek reimbursement from the facility.“


Connolly had previously posted seven issues for South Carolina, and earlier this week added five of these seven issues for Florida.  (excluding the bronchoscopy and blood transfusion approved issues).  This is the first posted issue that is looking to match a Part A stay with Part B services independently billed for the same stay that are included in the PPS.  This is a heads up to hospitals and social workers alike, and suggests that the RACs may also look to others professionals billing Medicare Part B for services that are included in the payment for the Part A stay, reports Nancy Beckley, a contributing editor for RACMonitor.com.

Keep checking at RACMonitor.com for further updates.

Chuck Buck

Chuck Buck is the publisher of RACmonitor and is the executive producer and program host of Monitor Mondays.

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