Test TablePress

THis is a test of a table imported via CSV, of RAC Issues

DescriptionIssue NameClaim TypeDate of ServiceRegions and StatesAdditional InformationIssue TypeDate ApprovedApproval Status
Durable Medical Equipment Drug and Biological Supplies should be billed in multiples of the dosage specified in the HCPCS code long descriptor. The number of units billed should be assigned based on the dosage increment specified in that HCPCS long descriptor, and correspond to the actual amount of the drug provided to the patient, including any appropriate, discarded drug waste. If the drug dose used in the care of a patient is not a multiple of the HCPCS code dosage descriptor, the provider rounds to the next highest unit. Drug waste should be coded according to the requirements of the local contractor. Claims suspected of billing an insufficient number of units will undergo a complex review to determine the correct number of billable/payable units.Insufficient Drug Units Billed - DME (At this time, Medical Necessity will be excluded from this review) - C003232012DME10/1/07 - PresentC - Alabama, Georgia, Tennessee1. Medicare Claims Processing Manual (IOM 100-4), Chapter 17, Section 10
2. Medicare Claims Processing Manual (IOM 100-4), Chapter 17, Section 40
3. Medicare Claims Processing Manual (IOM 100-4), Chapter 17, Section 70
4. Medicare Claims Processing Manual (IOM 100-4), Chapter 20, Section 140
5. LCD L27259 - Intravenous Immune Globulin
6. LCD L11555 - External Infusion Pumps
7. LCD L11521 - Immunosuppressive Drugs
8. L5007 - Nebulizers
9. Medicare Alpha-Numeric HCPCS, 2010 Alpha-Numeric HCPCS File
10. Medicare Alpha-Numeric HCPCS, 2011 Alpha-Numeric HCPCS File
11. Medicare Alpha-Numeric HCPCS, 2012 Alpha-Numeric HCPCS File
Complex11/20/2012Approved
Certain DME claims will be reviewed to determine if they were incorrectly billed.DME Duplicates - C001532012DME10/1/07 - PresentC - Alabama, Georgia, Tennessee1. Medicare Claims Processing Manual 100-04 section 120 Criteria for Detecting Potential Duplicates
2. Compilation of the Social Security Laws 1862(1)(a)
3. CGS LCD: L11443, L11445, L11446, L11448, L11451, L11517, L22664, L11519, L11554, L11555, L11556, L13877, L22664, L23613, L5007
Complex1/9/2013Approved
Overpayments were identified where ICD-9 codes were not in accordance with billing requirements outlined
in Local Coverage Determinations for DME orthotics.
Incorrect Billing of DME Orthotics - C000432014DME3 years from initial determinationC - Alabama, Georgia, Tennessee1. CGS LCD L22664 Knee Orthoses effective 7/1/2008
2. CGS LCD L11517 Ankle-Foot/Knee-Ankle-Foot Orthosis effective 10/1/1993
3. CGS LCD L11445 Orthopedic Footwear effective 1/1/1995
Automated4/28/2014Approved
A bi-level positive airway pressure device with back-up rate is not reasonable and necessary if the primary diagnosis is Obstructive Sleep Apnea. If billed with a diagnosis of OSA, it will be denied as not reasonable and necessary.Incorrect billing of a Bi-level Positive Airway Pressure Device -C001612011DME10/1/07 - PresentC - Alabama, Georgia, Tennessee1. LCD L11518Automated1/16/2013Approved
Medical documentation will be reviewed to determine if the Speech Generating Device and/or Accessories met coverage indications, limitations, and/or medical necessity as outlined in CGS LCD.Speech Generating Devices & Accessories - CGS - C004962013DME3 years from initial determination dateC - Alabama, Georgia, Tennessee1. CGS LCD L11524 effective 7/1/2001
2. Medicare NCD 50.1 effective 1/1/2001
3. CGS LCA A33754 effective 7/1/2005
Complex3/26/2014Approved
Overpayments were identified where claims billed for suction catheters were not in accordance with billing requirements outlined in Local Coverage Determinations.Suction Catheters for Tracheostomy - CGS - C000362014DME3 years from initial determination dateC - Alabama, Georgia, Tennessee1. CGS LCD L5027 effective 10/1/1993
2. CGS Article A24142 effective 1/2014
Automated3/26/2014Approved
Overpayments were identified where ICD-9 codes were not in accordance with billing requirements outlined in Local Coverage Determinations for DME devices.Incorrect Billing of DME Devices - CGS_C000392014DME3 years from initial determination dateC - Alabama, Georgia, Tennessee1. CGS LCD L12930 Mechanical In-exsufflation Devices effective 10/1/2003
2. CGS LCD L12934 High Frequency Chest Wall Oscillation Devices effective 10/1/2003
Automated4/8/2014Approved
Overpayments were identified where ICD-9 codes were not in accordance with billing requirements outlined
in Local Coverage Determinations for DME supplies.
Incorrect Billing of DME Supplies - CGS_C000422014DME3 years from initial determination dateC - Alabama, Georgia, Tennessee1. CGS LCD L11566 Urological Supplies effective 10/1/1993Automated4/8/2014Approved
Local Coverage Determination policy has indicated specific conditions and/or diagnoses that are covered for External Breast Prostheses.Inappropriate payments for an External Breast Prosthesis: C000932012DME10/1/07 - OpenC - Alabama, Georgia, Tennessee1. IOM 100-2 Chapter 15 Section 120
2. Cigna LCD L11554
Automated11/15/2012Approved
Coverage for aprepitant (J8501) is predicated by its use as the three drug combination of aprepitant, a 5-HT3 antagonist and dexamethasone and must be used in conjunction with one or more specified chemotherapuetic agents.Non-Covered use of Aprepitant (J8501) - DME : C000882012DME10/1/07 - PresentC - Alabama, Georgia, Tennessee1. Medicare Claims Processing Manual Chapter 17 - Drugs and Biologicals, Section 80.2.1
2. CMS Manual System Pub 100-04 Medicare Claims Processing, Transmittal 1281
3. MLN Matters Number: MM5655
4. Aprepitant (J8501) Package Labeling
5. NCD for Aprepitant for Chemotherapy-Induced Emesis (110.18)
Automated11/15/2012Approved