CMS has initiated the second volume of its Medicare Quarterly Compliance Newsletters, one year after the launching the inaugural edition of the publication. The newsletters are designed to offer providers guidance on avoiding common Medicare billing and general errors.
These educational newsletters are designed to help providers understand the major findings identified by Medicare administrative contractors (MACs), recovery auditors, program safeguard contractors (PSCs), zone program integrity contractors (ZPICs), and other governmental organizations, such as the Office of Inspector General. They aim to help providers, suppliers, and their staffs understand claims submission problems and how to avoid certain billing errors and other improper activities at their facilities.
CMS identifies recovery audit findings and offers guidance for the following issues: (Provider types affected in parentheses):
- Incorrect facility vs. non-facility reimbursement (Physicians who bill for services provided to a Medicare beneficiary in a facility setting)
- Unbundling of skilled nursing facility (SNF) services subject to consolidated billing (CB) (Physicians)
- Wheelchair unbundling (Durable medical equipment suppliers)
- Improper billing of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) during a Part A inpatient stay (DMEPOS suppliers)
- Improper billing of clinical social work (CSW) services during an inpatient hospital stay (CSWs providing services to Medicare beneficiaries in a covered Part A Inpatient Hospital stay)
- Validation of MS-DRGs with ventilator support of 96 or more hours (Inpatient hospitals)
- Improper coding of MS-DRG 853, infectious and parasitic diseases with operating room (OR) procedure and major complication or comorbidity (MCC) (Inpatient hospitals)
- Improper coding of coronary bypass with percutaneous transluminal coronary angioplasty (PTCA) with major complications and comorbidities (MCCs) MS-DRGs 231, 233, 235 (Inpatient hospitals)
- Improper coding of seizures MS-DRGs 100, 101 (Inpatient hospitals)
- Improper coding of nervous system disorders (Inpatient hospitals)
- Improper coding of lymphoma and non-acute leukemia with major complications/comorbidities (MCC) MS-DRG 840 (Inpatient hospital)