DRG 312 Reviews Put Providers 'In a Squeeze'

Healthcare providers in some regions are bracing for a twist to DRG 312 : Syncope and collapse have been  listed for review by more than one auditor, and at more than one point in the payment process.

DRG 312, the first issue approved for prepayment auditing, was also announced by the Medicare Recovery Audit Contractors (MAC) CIGNA Government Services (CGS) as an issue subject to complex medical review for J15 providers.

Ohio and Kentucky make up the J15 states. Ohio is also one the states in the prepayment review demonstration program. Although CMS stated in a December open door forum that claims subject to prepayment review would be off-limits from future postpayment reviews from MACs and Recovery Auditors, it still remains to be seen how this will be done.

This puts providers in a difficult position, according to Nancy Beckley, MS, MBA, CHC, president, Nancy Beckley & Associates, LLC, in Milwaukee, WI.