This is the first list of medical necessity-specific audits to be announced since the Aug. 10 report that CMS’s New Issue Review Board approved as the first “medical necessity review” audits for RACs to begin posting to their respective websites.

As of today, the CGI RAC website lists six of the 18 issues, with an Aug. 6 approval date:

Issue Name	Issue Type	Claim Types	States	Date Approved
Atherosclerosis w MCC MS-DRG 302 (Medical Necessity Review and MS-DRG Validation)	Complex	Inpatient	IL, IN, KY, MI, MN, OH, WI	8/6/2010
Chest Pain MS-DRG 313 (Medical Necessity Review and MS-DRG Validation)	Complex	Inpatient	IL, IN, KY, MI, MN, OH, WI	8/6/2010
Other Circulatory System Diagnoses w MCC MS-DRG 314, 315, 316 (Medical Necessity Review and MS-DRG Validation)	Complex	Inpatient	IL, IN, KY, MI, MN, OH, WI	8/6/2010
Other Vascular Procedures w CC, w/o CC/MCC MS-DRG 253, 254 (Medical Necessity Review and MS-DRG Validation)	Complex	Inpatient	IL, IN, KY, MI, MN, OH, WI	8/6/2010
Red Blood Cell Disorders w MCC MS-DRG 811 (Medical Necessity Review and MS-DRG Validation)	Complex	Inpatient	IL, IN, KY, MI, MN, OH, WI	8/6/2010
Syncope & Collapse MS-DRG 312 (Medical Necessity Review and MS-DRG Validation)	Complex	Inpatient	IL, IN, KY, MI, MN, OH, WI	8/6/2010

So far, the other three RAC auditors have yet to post any approved issues to their sites.

AHA: http://www.aha.org/aha/content/2010/pdf/100813-new-issue-racb.pdf

CGI: http://racb.cgi.com/Issues.aspx

Medical Necessity Has Arrived

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