August 27, 2011

RAC Region D Posts 21 Inpatient Issues

By

klong100alert-powered-by-decision-health

 

 

 

 

 

 

 

HealthDataInsights, the recovery auditor for Region D, recently posted 21 issues that were approved between July 27 and Aug. 11.

The RACs will examine whether services are medically necessary for the inpatient hospital issues.

The other three RACs have not posted issues this past week.

Part A Inpatient

Name of issue

Date posted or approved

Regions/states where it is active

Description of issue

Document sources

Acute inpatient hospitalization - Multiple sclerosis and cerebellar atazia w/CC (DRG 059)

7/27/11

RAC Region D

Medicare pays for inpatient hospital services that are medically necessary for the setting billed. Medical documentation will be reviewed to determine that services were medically necessary.

CMS Pubs 100-02, 100-08

Acute inpatient hospitalization - Ear, nose, mouth and throat malignancy without CC/MCC (DRG 148)

8/5/11

RAC Region D

Medicare pays for inpatient hospital services that are medically necessary for the setting billed. Medical documentation will be reviewed to determine that services were medically necessary.

CMS Pubs 100-02, 100-08

Acute inpatient hospitalization - Other disorders of the eye w/MCC (DRG 124)

8/5/11

RAC Region D

Medicare pays for inpatient hospital services that are medically necessary for the setting billed. Medical documentation will be reviewed to determine that services were medically necessary.

CMS Pubs 100-02, 100-08

Acute inpatient hospitalization - neurological eye disorders (DRG 123)

8/5/11

RAC Region D

Medicare pays for inpatient hospital services that are medically necessary for the setting billed. Medical documentation will be reviewed to determine that services were medically necessary.

CMS Pubs 100-02, 100-08

Acute inpatient hospitalization - otitis media and URI w/MCC (DRG 152)

8/5/11

RAC Region D

Medicare pays for inpatient hospital services that are medically necessary for the setting billed. Medical documentation will be reviewed to determine that services were medically necessary.

CMS Pubs 100-02, 100-08

Acute inpatient hospitalization - red blood cell disorders w/MCC (DRG 811)

8/5/11

RAC Region D

Medicare pays for inpatient hospital services that are medically necessary for the setting billed. Medical documentation will be reviewed to determine that services were medically necessary.

CMS Pubs 100-02, 100-08

Acute inpatient hospitalization - inflammation of the male reproductive system w/o MCC (DRG 728)

8/5/11

RAC Region D

Medicare pays for inpatient hospital services that are medically necessary for the setting billed. Medical documentation will be reviewed to determine that services were medically necessary.

CMS Pubs 100-02, 100-08

Acute inpatient hospitalization - otitis media and URI w/o MCC (DRG 153)

8/5/11

RAC Region D

Medicare pays for inpatient hospital services that are medically necessary for the setting billed. Medical documentation will be reviewed to determine that services were medically necessary.

CMS Pubs 100-02, 100-08

Acute inpatient hospitalization - acute major eye infections w/CC/MCC (DRG 121)

8/5/11

RAC Region D

Medicare pays for inpatient hospital services that are medically necessary for the setting billed. Medical documentation will be reviewed to determine that services were medically necessary.

CMS Pubs 100-02, 100-08


 

Name of issue Date posted or approved Regions/states where it is active Description of issue Document sources
Acute inpatient hospitalization – multiple sclerosis and cerebellar ataxia w/o CC/MCC (DRG 060) 8/5/11RAC RAC Region D Medicare pays for inpatient hospital services that are medically necessary for the setting billed. Medical documentation will be reviewed to determine that services were medically necessary. CMS Pubs 100-02, 100-08
Acute inpatient hospitalization – degenerative nervous system disorders w/o MCC (DRG 057) 8/5/11 RAC Region D Medicare pays for inpatient hospital services that are medically necessary for the setting billed. Medical documentation will be reviewed to determine that services were medically necessary. CMS Pubs 100-02, 100-08
Acute inpatient hospitalization – degenerative nervous system disorders w/MCC (DRG 056) 8/5/11 RAC Region D Medicare pays for inpatient hospital services that are medically necessary for the setting billed. Medical documentation will be reviewed to determine that services were medically necessary. CMS Pubs 100-02, 100-08
Acute inpatient hospitalization – acute ischemic stroke with use of thrombolytic agent w/CC (DRG 062) 8/5/11 RAC Region D Medicare pays for inpatient hospital services that are medically necessary for the setting billed. Medical documentation will be reviewed to determine that services were medically necessary. CMS Pubs 100-02, 100-08
Acute inpatient hospitalization – nonspecific CVA and precerebral occlusion without infarct w/MCC (DRG 067) 8/5/11RAC RAC Region D Medicare pays for inpatient hospital services that are medically necessary for the setting billed. Medical documentation will be reviewed to determine that services were medically necessary. CMS Pubs 100-02, 100-08
Acute inpatient hospitalization – intracranial hemorrhage or cerebral infarction w/CC (DRG 065) 8/5/11 RAC Region D Medicare pays for inpatient hospital services that are medically necessary for the setting billed. Medical documentation will be reviewed to determine that services were medically necessary. CMS Pubs 100-02, 100-08
Acute inpatient hospitalization – intracranial hemorrhage or cerebral infarction w/MCC (DRG 064) 8/5/11 RAC Region D Medicare pays for inpatient hospital services that are medically necessary for the setting billed. Medical documentation will be reviewed to determine that services were medically necessary. CMS Pubs 100-02, 100-08
Acute inpatient hospitalization – traumatic stupor and coma, coma greater than one hour w/CC (DRG 083) 8/11/11 RAC Region D Medicare pays for inpatient hospital services that are medically necessary for the setting billed. Medical documentation will be reviewed to determine that services were medically necessary. CMS Pubs 100-02, 100-08
Acute inpatient hospitalization – traumatic stupor and coma, coma less than one hour w/MCC (DRG 085) 8/11/11 RAC Region D Medicare pays for inpatient hospital services that are medically necessary for the setting billed. Medical documentation will be reviewed to determine that services were medically necessary. CMS Pubs 100-02, 100-08
Acute inpatient hospitalization – traumatic stupor and coma, coma greater than one hour w/MCC (DRG 082) 8/11/11 RAC Region D Medicare pays for inpatient hospital services that are medically necessary for the setting billed. Medical documentation will be reviewed to determine that services were medically necessary. CMS Pubs 100-02, 100-08
Acute inpatient hospitalization – nontraumatic stupor and coma w/MCC (DRG 080) 8/11/11 RAC Region D Medicare pays for inpatient hospital services that are medically necessary for the setting billed. Medical documentation will be reviewed to determine that services were medically necessary. CMS Pubs 100-02, 100-08
Acute inpatient hospitalization – nontraumatic stupor and coma w/o MCC (DRG 081) 8/11/11 RAC Region D Medicare pays for inpatient hospital services that are medically necessary for the setting billed. Medical documentation will be reviewed to determine that services were medically necessary. CMS Pubs 100-02, 100-08

 

About the Author

Karen Long is the compliance product manager for DecisionHealth and oversees products that relate to fraud and abuse and HIPAA compliance for physician offices and home health agencies, and accreditation compliance for hospitals. In her almost four years at DecisionHealth, Karen also has been the compliance editor and a reporter for Home Health Line, nation's leading independent authority on home healthcare business, regulation and reimbursement.

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KLong@decisionhealth.com

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Karen Long

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