Updated on: June 22, 2012

RAC Region A Posts First Set of CMS Approved Issues

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Original story posted on: September 21, 2009

MONDAY, SEPTEMBER 21, 2009----DCS, the Recovery Audit Contractor for Region A, has posted its first CMS approved issues to its Web site.


Three issues, all affecting DME suppliers, are applicable for the District of Columbia, Connecticut, Massachusetts, Maryland, Maine, Delaware, New Jersey, New York, New Hampshire, Pennsylvania Rhode Island and Vermont.


The issue of Pharmacy Supply and Dispensing Fees premiers this week as a new issue approved by CMS.  The other DME issues approved for Region A of Wheelchair Bundling and Urological Bundling, had previously been approved for Connolly, the RAC in Region C.


The issues have been posted as follows to the DCS Web site on the issues page.  (source:  dcsrac.com)


Pharmacy Supply and Dispensing Fees:


Pharmacy supply and dispensing fees when billed by a DME supplier are required to be accompanied with an oral anti-cancer, oral anti-emetic, immunosuppressive drug or inhalation drug. The absence of one of the aforementioned drugs billed on the same date of service or a denial of one of the aforementioned drugs represents an overpayment.


Wheelchair Bundling:


A potential vulnerability may exist if certain procedure codes are billed in conjunction with other procedure codes for the same date of service and the same beneficiary.


Urological Bundling:


A potential vulnerability may exist if certain urological procedure codes are billed in conjunction with other urological procedure codes for the same date of service and same beneficiary.


The only states that do not have approved issues for automated reviews are Illinois, Kentucky, Ohio, and Wisconsin.  All four RACs have now posted approved CMS issues for automated reviews.


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Chuck Buck

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

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