Three RACs have all posted new issues in the past two weeks. Medical necessity reviews are still not approved. The new issues are listed below:
Region A
The RAC for Region A (DCS) posted several new issues, mostly for Automated Review:
Blood Transfusions |
Bronchoscopy Services |
Duplicate Claims - Part B |
Global Billing of Radiology or Diagnostic Tests in the Facility Setting |
Global vs. TC/PC Split Reimbursements |
IV Hydration |
MSDRGs 177, 189, 193, 291, 438, 441, 444, 592, 602, 682, 689, 691, 693: MS-DRG Validation for Severe Sepsis |
MSDRGs 216, 217, 218, 219, 220, 221: MS-DRG Validation for Cardiac Valve Procedures |
MSDRGs 234, 236: MS-DRG Validation for Coronary Bypass |
MSDRGs 335, 336, 337, 350, 351, 352, 353, 354, 355: MS-DRG Validation for Lysis of Adhesions |
MSDRGs 463, 464, 465, 573, 574, 575, 901, 902, 903: MS-DRG Validation for Excisional Debridement |
National Correct Coding Initiative - Part B |
Neulasta |
New Patient Visits |
Newborn/Pediatric Codes |
Once In A Lifetime |
Parenteral Nutrition Additives with Premix Solutions |
Technical Component of Radiology |
Untimed Codes |
Initial/Preparatory Knee Disarticulation Prosthesis |
Manual Wheelchair Accessories Billed With Power Wheelchair Basesp> |
Region C
Connolly added two DRG Validations and one issue for Automated review:
Lymphoma and Nonacute Leukemia with MCC: MS-DRG 840 |
Percutaneous Cardiovascular Procedure with Drug-Eluting Stent without MCC: MS-DRG 247 |
Region D
HDI added a single issue for Automated review:
Incorrect Patient Status - Acute |
When Will Medical Necessity Reviews Begin?
No one knows but the RACs, and so far, they ain't sayin'.
About the Author
Ernie de los Santos is the chief information officer for eduTrax®. He joined the company at its inception and has been responsible for the creation, development and maintenance of the eduTrax® portals - a set of Web site devoted to providing knowledge, resources and compliance aids for U.S. healthcare professionals who are involved in revenue cycle management.
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