Medicare Quarterly Provider Compliance Newsletter

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The Medicare Quarterly Provider Compliance Newsletter

The purpose behind the newsletter is to assist providers by identifying common billing problems and addressing the ways that providers can avoid these problems.

This inaugural newsletter included the following topics:

• 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

source  CMS.gov