Recovery Audit Contractors (RACs) are companies that contract with CMS to find improper payments (both overpayments and underpayments) that may have been made to Medicare providers. Section 302 of the Tax Relief and Health Care Act of 2006 made the RAC Program permanent. RACs review claims on a post payment basis. There are two types of reviews conducted by RACs: Automated (no medical record...
What should you do if you disagree with your RAC overpayment determination? The below chart breaks down the different options providers have when disputing a RAC overpayment determination. Provider Options - RAC Overpayment Determination Discussion Period Rebuttal Redetermination Which option should I use? The discussion period offers the opportunity for the provider to...
New information from the Medicare Learning Network: CMS has released two new HIPAA Version 5010 fact sheets, as well as two companion checklists, to assist providers in transitioning to 5010. Version 5010 is the new version of the X12 standards for HIPAA transactions; version D.0 is the new version of the National Council for Prescription Drug Program (NCPDP) standards for pharmacy and supplier...
The purpose of this article is to provide education on medical necessity of B-Type Natriuretic Peptide (BNP) services in response to denials noted through the NAS Medical Review department. BNP is synthesized and released from the heart, and elevated levels may lend support to a diagnosis of abnormal ventricular function or hemodynamics. Used in conjunction with other clinical information, it may...
On March 2, 2010, President Obama signed into law the "Temporary Extension Act of 2010." Among other things, this law extends through March 31, 2010, the zero percent update to the Medicare Physician Fee Schedule that was in effect for claims with dates of service January 1, 2010, through February 28, 2010. Consequently, effective immediately, claims with dates of service March 1 and later which...
Any provider or organization that did not respond to the October revalidation request will have their Medicare PTANs revoked by the end of January 2010.
Recent Comprehensive Error Rate Testing (CERT) analysis revealed an increase in errors due to incorrect coding for CPT 85025 and 85027. The findings show that providers are billing CPT 85027 when documentation supports CPT 85025. CPT: Description: 85025 Complete Blood Count, with differential WBC, automated 85027...
The correct code for billing UroVysion is 88299. This article was revised on August 4, 2008 to change the code that should be billed for UroVysion testing. The correct code for billing is 88299 - Unlisted cytogenetic study instead of 88399. This revision corrects and clarifies appropriate billing of UroVysion and it replaces all previous articles on this subject.
This article clarifies appropriate billing of UroVysion" and it replaces all previous articles on this subject. UroVysion is an FDA-approved, proprietary, bladder cancer kit using fluorescent in-situ hybridization (FISH) testing with multiple probes performed simultaneously. It is marketed by Abbott Laboratories and used as an aid in patients with hematuria for the initial diagnosis of...