HealthDataInsights, Inc, the RAC for Region D, has initiated automated audits.
HealthDataInsights, Inc, the
RAC for Region D, has initiated automated audits. Issues approved by CMS are as follows:
- Newborn Pediatric CPT
Codes Billed for Patients Exceeding Age Limit. Description:
Certain service codes are specific to patients of a specific age and
should not be applied/billed for patients which exceed the age limit
defined by the CPT Code.
- Once in a Lifetime.
Description: Certain procedures are only performed once in a person’s
lifetime.
- Excessive
Units-Untimed Codes. Description: When reporting services
units for untimed codes (excluding Modifiers –KX, and -59) where the
procedure is not defined by a specific timeframe, the provider should
enter a 1 in the units bill column per date of service.
- Excessive Units-Blood
Transfusion. Description: Blood Transfusions
should be billed with a maximum of (1) unit per patient per date of
service.
- Excessive Units. Description: Bronchoscopy services should be
billed with a maximum number of units (1) per patient per date of service
- Excessive Units – IV
Hydration. Description: IV Hydration should be billed with
a maximum number of units (1) per patient per date of service.
- Neulasta.
Description: Neulasta (HCPCS Code J2505) Claims submitted with the total
number milligrams instead 1 unit per 6 mg. Claims for J2505 should be submitted so that the units
billed represent the number of multiples of 6mg administered, not the
total number of mgs.
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