The maximum number of requests – 300 every 45 days – remains unchanged since its implementation Nov. 2, 2010.

For more information on the change, log onto www.cms.gov/rac or http://www.aha.org/aha/content/2011/pdf/11racadrlimits.pdf.

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New RAC Issues Posted

RAC regions B and D posted new issues this week. CGI Federal, the RAC for Region B, posted one issue related to durable medical equipment claims. HealthDataInsights, the RAC for Region D, posted two issues related to Part B claims.

Durable medical equipment (DME)

Name of issue

Date posted or approved

Regions/states where it is active

Description of issue

Document sources

Multiple DME rentals billed per month

8/5/11

RAC Region B

Medicare makes payments on a monthly basis for the rental of DMEPOS Fee Schedule items. The first claim’s billing date for the DMEPOS rental item is designated as the anniversary date. All subsequent billing must be dated monthly with the anniversary date. If a claim is submitted with a date that is earlier than the anniversary date and that DMEPOS item is not a replacement for a lost, stolen or irreparable damaged DMEPOS item, then the claim represents an overpayment.

Social Security Act, Volume 1, Title XVIII; Federal regulations: Title 42 CFR Public Health; CMS IOM 100-04; Jurisdiction B DME MAC Supplier Manual Chapter 15

 

Part B

Name of issue

Date posted or approved

Regions/states where it is active

Description of issue

Document sources

Facet joints denervation billed without guidance J1-by ASC

7/22/11

Calif., Hawaii, Nev.

In accordance with LCD L28288, Facet Joint Denervation requires placement of a needle in the facet joint under fluoroscopic or CT guidance. This requirement is effective for dates of service on or after Sept. 2, 2008, in California, Nevada and Hawaii.

LCD 28288, MLN Matters Number: MM6960; CMS Pub 100-04

Age-appropriate code for end stage renal disease (ESRD) services

7/22/11

RAC Region D

The beneficiary’s age at the end of the month is the age of the patient for determining the appropriate age based ESRD-related services code.

CMS Pub 100-04

 

About the Author

Karen Long is the compliance product manager for DecisionHealth and oversees products that relate to fraud and abuse and HIPAA compliance for physician offices and home health agencies, and accreditation compliance for hospitals. In her almost four years at DecisionHealth, Karen also has been the compliance editor and a reporter for Home Health Line, nation’s leading independent authority on home healthcare business, regulation and reimbursement.

Contact the Author

KLong@decisionhealth.com

To comment on this article please go to editor@racmonitor.com

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