RAC Focus: Medically Unlikely Edits (MUEs)
RAC Focus: Drugs & Biologicals
RAC Focus: Documentation Hot Spots (Historical)
RAC Focus: Colonoscopies and EGDs
RAC Focus: Principal Diagnosis
RAC Focus: Secondary Diagnosis (Historical)
Modifier -59: “Distinct Procedural Service: Under certain circumstances, the physician may need to indicate that a procedure or service was distinct or independent from other services performed on the same day. Modifier 59 is used to identify procedures/services that are not normally reported together, but are appropriate under the circumstances. This may represent a different […]
Here is the relevant text in the Change: 3.14 – Clinical Review Judgment (CRJ) (Rev. 338, Issued: 05-14-10, Effective: 04-23-10, Implementation: 06-15-10) A. Contractors to Which This Section Applies This section applies to ACs, MACs, CERT, RACs, PSCs, and ZPICs, as indicated below. B. General The CRJ involves two steps: (1) the synthesis of all […]
The Affordable Care Act: New Tools to Fight Fraud, Strengthen Medicare and Protect Taxpayer Dollars The Affordable Care Act will improve and expand consumer protections, strengthen Medicare, and reduce health care costs. One important way it achieves these goals is by improving government-wide efforts to fight fraud and waste. The new law contains some critical […]