You may remember our June 9 post discussing Ohio Recovery Audit Contractors (RAC). Now, all four RACs have now posted approved CMS issues for automated reviews on their websites.
The only states that do not have approved issues for automated reviews are Illinois, Kentucky, Ohio, and Wisconsin which are included in Region B. The Recovery Audit Contractor for Region B is CGI. CGI just posted its first three issues to its website on August 26, 2009 for the target states of Indiana, Michigan and Minnesota. These three states originally had a RAC phase-in date of March 1, 2009. Illinois, Kentucky, Ohio and Wisconsin had a phase-in date of August 1, 2009. It would appear that CGI is somewhat behind schedule.
The three issues recently approved for automated review by CGI are:
- Blood transfusions – should be billed with a maximum of one unit per patient per date of service.
- IV Hydration – should be billed with a maximum of one initial unit per patient per date of service. This involves CPT codes 90760 for services prior to January 1, 2009 and 96360 for dates of service after January 1, 2009.
- Bronchoscopy services – should be billed with a maximum of one unit per patient per date of service.
All three issues are aimed at Outpatient Hospital and Physician claim types.
Automated reviews can only begin if three conditions are met:
- Issues must be posted on the RAC website first.
- Provider outreach must have been conducted in the states targeted for the reviews.
- If a Medicare Administrative Contractor (MAC) transition is taking place, reviews are to be delayed or suspended until the transition is complete.
Inasmuch as the RAC provider outreach is still being conducted in Ohio, it would appear that automated reviews in Ohio are not ready for implementation. As a matter of fact, only a handful of provider outreach sessions have been conducted in the state. Primary target audiences have included Rehabilitation Facilities, Hospitals, Home Care Agencies, and Ambulatory Surgery Centers. Future Ohio sessions currently scheduled include Skilled Nursing Facilities (November 4, 2009). As of this time, there are no sessions specifically for DME or physician providers in Ohio.
If you would like to sponsor an outreach session for your organization or group, you may submit a formal request to CGI via email: firstname.lastname@example.org. Include 3 possible dates and times for the outreach session as well as the type of session requested – personal conference, webinar, or teleconference. CGI will forward your request to CMS for approval. This usually takes two weeks. The requesting organization would be responsible for handling the registration.
The CMS website has an updated provider outreach schedule posted for each region. Click here to view this schedule.
If you have any questions, please contact Skoda Minotti’s Healthcare Consulting Group at 440-449-6800.
Topics: Ohio Healthcare Consulting