New issues posted to the DCS Recovery Audit Contractor Website

Diversified Collection Services (DCS) is the Recovery Audit Contractor for the states of Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island and Vermont. The following issue concerning Hepatic Function Panel Testing is under review for laboratories in CT and NY.

Issues Under Review
Issue Name: Hepatic Function Panel Testing - J13
Issue Number: A001172012
Issue Description: Potential incorrect billing occurred for claims billed with ICD-9-CM codes that are not listed by National Government Services (NGS) Local Coverage Determination (LCD) L27377 (A47395) as medically necessary.
Type of Review: Automated
State(s) Impacted: CT, NY
Provider Type: Laboratory
Date Posted: August 6, 2012
Date Revised: No Revision
Dates of Service: Claims having a "claim paid date" which is more than 3 years prior to the ADR date will be excluded.

NHIC (National Heritage Insurance Company) J14 MAC for Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont

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