CMS Identifies Recovery Auditor Findings

As has been the case, these documents are provided in order to propagate information on understanding claims submission problems while also providing guidance on avoiding such errors and improper billing activities moving forward. As auditing bodies continue to grow and evolve, the addition of CERT findings only makes sense.

In the report, CMS identified the following findings. affected provider types are in parentheses:

CERT findings

• Three-day qualifying hospital stay for skilled nursing facility stays (Inpatient hospitals, SNFs)
• Inpatient hospital consultations (Inpatient hospitals)

Recovery audit findings

• Cholecystectomy-incorrect secondary diagnosis (Inpatient hospitals)
• Kidney and urinary tract disorder - incorrect principal diagnosis (Inpatient hospitals)
• Transient ischemic attack - services rendered in a medically unnecessary setting (Inpatient hospitals)
• Craniotomy and endovascular intracranial procedures (Inpatient hospitals)
• Small and large bowel procedures (Inpatient hospitals)
• Spinal fusion (Inpatient hospitals)