Medicare Quarterly Provider Compliance Newsletter

Introducing the new Medicare Quarterly Provider Compliance Newsletter

• Inpatient Hospital and Skilled Nursing Facilities Fail to Submit Requested Documentation
• Other Services with Excessive Units - Units Billed Exceeded the Number Approved per Current Procedural Terminology/Healthcare Common Procedure Coding System (CPT/HCPCS) Code Descriptions
• Inpatient Hospital Services - Respiratory System Diagnosis with Ventilator Support: Principal Diagnosis on the Claim Did Not Match the Principal Diagnosis in the Medical Record
• Other Cardiac Pacemaker Implantation (DRG 116) - Not Medically Necessary to Receive Care in Inpatient Setting
• Inpatient Hospital Services - Heart Failure and Shock (DRG 127) Criteria for Inpatient Care Not Met
• Other Drug Codes - Incorrect Number of Units Billed
• Inpatient Hospital Services - Medical Record Did Not Include Sufficient Documentation
• Physician Pharmaceutical Injectables - Incorrect Procedure Codes and/or Number of Units Billed