Last RAC Announces First Issues for Audits
The three issues, including one new issue not yet approved in other RAC regions, are applicable to durable medical equipment (DME) suppliers in Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont.
According to the DCS Web site, the issues include the following:
- 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 DCS Web site also lists several helpful samples and links for providers, including a sample automated review demand letter, a sample complex demand letter, a sample envelope, letterhead, and more.
The RACs from regions B, C, and D have already posted approved issues for most other states. The only states CMS has not yet approved any RAC audit issues for are the Region B states Illinois, Kentucky, Ohio, and Wisconsin.
Editor's note: For the latest news on CMS-approved issues for DCS and other RACs, visit the Revenue Cycle Institute Web site. (For an updated list of approved issues in your state, visit the “Tools” section of the Revenue Cycle Institute Web site and download the free chart.)
Andrea Kraynak, CPC, is senior managing editor of Medical Records Briefing and HIM Connection. She may be reached at firstname.lastname@example.org.
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