The results of recent recovery audit contractor (RAC) automated reviews of hospital services were outlined in the January 2013 Medicare Quarterly Provider Compliance Newsletter, Volume 3, Issue 2 . Among the hot topics discussed was a significant issue for physician providers: the RACs identified that inappropriate current procedural terminology (CPT) codes were being assigned for related professional evaluation and management (E/M) services “rendered in swing bed facilities (with nursing facility levels of care)” in the same episode of care as an acute inpatient stay, when the patient was not “on a leave of absence from the hospital.” Specifically, inpatient hospital CPT codes, i.e
On Monday, May 21, 2012, the Centers for Medicare & Medicaid (CMS) published a reminder that, effective for services provided on or after July 1, 2012, the statutory moratorium allowing certain pathologists and independent laboratories to bill for the technical component (TC) of pathology services expires. This means the TC for those surgical pathology services provided under arrangement to Medicare hospital patients only will be considered covered and payable by Medicare if billed by the hospital. The hospital will receive additional payment under the Outpatient Prospective Payment System (OPPS) for services provided to outpatients, but such services are considered included in the diagnosis-related group reimbursement for inpatients