Percutaneos transluminal angioplasty (PTA) procedures too under RAC spotlight!
Make sure your physician does not bill an initial hospital care code for seeing someone in the morning and then follows it up with subsequent care code for seeing her in the afternoon. If he does that, you could invite scrutiny from one Recovery Audit Contractor (RAC). Here are some audit areas that impact Part B services.
RAC Contractor – CGI Technologies – is focusing its efforts on physicians who collected money for both initial and subsequent hospital care on the same day.
Hospital billing: Initial hospital care and subsequent hospital care
Your physician is not allowed to bill both initial hospital care and subsequent care codes when he sees a patient more than once – even if he deems his second visit to be “subsequent” care. Seasoned coders know this well but this is an issue that CGI Technologies would be reviewing.
According to CGI, both initial hospital care and subsequent hospital care codes can be reported only once per day by the same physicians of the same specialty from the same group practice. In such scenarios, the physician can report the initial hospital care code if he is the first person to check the patient upon arrival. He should bill the subsequent care codes the next day only. The RAC contractor will collect from physicians who billed both initial and subsequent care codes on the same day. During its audit, it will also be checking claims with Date of Service (DOS) as far back as October 1, 2010.
In CMS’ Section 30.6.9 of the Medicare Claims Processing Manual, the inpatient hospital visit descriptors contain the phrase “per day”. This means that the code and the pay for the code stand for all services provided on that date. Your physician should go for a code that covers all services during the DOS.
Places where this audit will be applicable: Minnesota, Wisconsin, Indiana, Ohio and Kentucky.
RAC Contractor - Connolly Consulting is eyeing Percutaneous transluminal angioplasty (PTA)
Connolly Consulting would be checking medical documentation to determine if the PTA was reasonable and necessary. This audit will apply to all claims with DOS within the last three years. So if your cardiologist schedules too much PTA procedures, make sure he has documentation supporting the medical necessity of the surgeries or be ready to face heavy casualties.
Make sure your physician does not bill an initial hospital care code for seeing someone in the morning and then follows it up with subsequent care code for seeing her in the afternoon. If he does that, you could invite scrutiny from one Recovery Audit Contractor (RAC). Here are some audit areas that impact Part B services.
RAC Contractor – CGI Technologies – is focusing its efforts on physicians who collected money for both initial and subsequent hospital care on the same day.
Hospital billing: Initial hospital care and subsequent hospital care
Your physician is not allowed to bill both initial hospital care and subsequent care codes when he sees a patient more than once – even if he deems his second visit to be “subsequent” care. Seasoned coders know this well but this is an issue that CGI Technologies would be reviewing.
According to CGI, both initial hospital care and subsequent hospital care codes can be reported only once per day by the same physicians of the same specialty from the same group practice. In such scenarios, the physician can report the initial hospital care code if he is the first person to check the patient upon arrival. He should bill the subsequent care codes the next day only. The RAC contractor will collect from physicians who billed both initial and subsequent care codes on the same day. During its audit, it will also be checking claims with Date of Service (DOS) as far back as October 1, 2010.
In CMS’ Section 30.6.9 of the Medicare Claims Processing Manual, the inpatient hospital visit descriptors contain the phrase “per day”. This means that the code and the pay for the code stand for all services provided on that date. Your physician should go for a code that covers all services during the DOS.
Places where this audit will be applicable: Minnesota, Wisconsin, Indiana, Ohio and Kentucky.
RAC Contractor - Connolly Consulting is eyeing Percutaneous transluminal angioplasty (PTA)
Connolly Consulting would be checking medical documentation to determine if the PTA was reasonable and necessary. This audit will apply to all claims with DOS within the last three years. So if your cardiologist schedules too much PTA procedures, make sure he has documentation supporting the medical necessity of the surgeries or be ready to face heavy casualties.
This audit is applicable for all of Region C. Your local MAC might have different coverage criteria; so make sure you check your local services prior to billing Percutaneous transluminal angioplasty services.
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