CMS has released its second FY 2012 issue of the Medicare Quarterly Provider Compliance Newsletter (Vol. 2, Issue 2, January 2012). This issue of the newsletter highlights major findings identified by RACs in audits of inpatient hospitals and DME suppliers. It is a good heads-up for providers on hot compliance issues and provides some guidance and resources to help tackle the problem. If you are trying to identify topics for training sessions, this is a good place to start. The current topics include:
Inpatient hospital
- Ambulance Services Separately Payable During an Inpatient Hospital Stay
- Diseases and Disorders of the Circulatory System (MS-DRG 312, MS-DRG 313)
- Minor Surgery and Other Treatment Billed as Inpatient Stay
- Respiratory System Diagnosis Related Group (DRG) 076, Medicare Severity Diagnosis Related Groups (MS-DRGs) 166,167, 177, 178, and 179 (ICD-9-CM Procedure Code 33.27)
- Chronic Obstructive Pulmonary Disease (COPD) Medicare Severity Diagnosis Related Group (MS-DRGs) 190, 191, and 192 (Medical Necessity Review and MS-DRG Validation)—Inappropriate and Insufficient Documentation
DME
- Billing for Arformoterol (Brovana) (J7605) and Formoteral fumarate (Perforomist) (Q4099
- Lower Limb Suction Valve Prosthesis
- Overutilization of Positive Airway Pressure (PAP) and Respiratory Assist Device (RAD) Accessories—Improperly Billed Quantities
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