A program that will require payment preapproval from CMS for cardiac and orthopedic procedures is currently limited to Florida, according to a Bloomberg report.
On Nov. 15, CMS announced it will be launching three demonstration programs in Jan. 2012 to cut improper payments, reduce overall payment errors and eliminate unnecessary procedures within Medicare and Medicaid. One of those programs will be the Recovery Audit Prepayment Review, which will allow Medicare recovery auditors to conduct prepayment reviews on certain types of claims that historically result in high rates of improper payments.
This program initially focused on 11 states, Florida included. However, some analyst reports indicate the version will only target Florida due to the 2012 election year, according to the report.
Hospital and medical device stocks tumbled this past weekend after a report indicated cardiac care, joint replacements and spinal fusion procedures in the 11 states would require the prepayment audits, according to a Bloomberg/San Francisco Chronicle report. Shares for Nashville, Tenn.-based Hospital Corporation of America and Franklin, Tenn.-based Community Health Systems fell 7.2 percent and 5.4 percent, respectively, but have since rebounded.
The list of DRGs for Florida inpatient hospital claims, as listed by Florida's First Coast Service Options, that will be subject to 100-percent prepayment medical review include the following:
• 226 — Cardiac defibrillator implant without cardiac catheter with major complications or comorbitities
• 227 — Cardiac defibrillator implant without cardiac catheter without MCC
• 242 — Permanent cardiac pacemaker implant with MCC
• 243 — Permanent cardiac pacemaker implant with CC
• 244 — Permanent cardiac pacemaker implant with CC or MCC
• 245 — Automatic implantable cardiac defibrillator generator procedures
• 247 — Percutaneous cardiovascular procedure with drug eluding stent without MCC
• 251 — Percutaneous cardiovascular procedure without coronary artery stent without MCC
• 253 — Other vascular procedures with CC
• 264 — Other circulatory system or procedures
• 287 — Circulatory disorders except acute myocardial infarction with cardiac catheter without MCC
• 458 — Spinal fusion except cervical with spinal curve, malign or 9+ fusions without CC
• 460 — Spinal fusion except cervical without MCC
• 470 — Major joint replacement or reattachment of lower extremity without MCC
• 490 — Back and neck procedures except spinal fusion with CC, MCC or disc device/neurostimulator
On Nov. 15, CMS announced it will be launching three demonstration programs in Jan. 2012 to cut improper payments, reduce overall payment errors and eliminate unnecessary procedures within Medicare and Medicaid. One of those programs will be the Recovery Audit Prepayment Review, which will allow Medicare recovery auditors to conduct prepayment reviews on certain types of claims that historically result in high rates of improper payments.
This program initially focused on 11 states, Florida included. However, some analyst reports indicate the version will only target Florida due to the 2012 election year, according to the report.
Hospital and medical device stocks tumbled this past weekend after a report indicated cardiac care, joint replacements and spinal fusion procedures in the 11 states would require the prepayment audits, according to a Bloomberg/San Francisco Chronicle report. Shares for Nashville, Tenn.-based Hospital Corporation of America and Franklin, Tenn.-based Community Health Systems fell 7.2 percent and 5.4 percent, respectively, but have since rebounded.
The list of DRGs for Florida inpatient hospital claims, as listed by Florida's First Coast Service Options, that will be subject to 100-percent prepayment medical review include the following:
• 226 — Cardiac defibrillator implant without cardiac catheter with major complications or comorbitities
• 227 — Cardiac defibrillator implant without cardiac catheter without MCC
• 242 — Permanent cardiac pacemaker implant with MCC
• 243 — Permanent cardiac pacemaker implant with CC
• 244 — Permanent cardiac pacemaker implant with CC or MCC
• 245 — Automatic implantable cardiac defibrillator generator procedures
• 247 — Percutaneous cardiovascular procedure with drug eluding stent without MCC
• 251 — Percutaneous cardiovascular procedure without coronary artery stent without MCC
• 253 — Other vascular procedures with CC
• 264 — Other circulatory system or procedures
• 287 — Circulatory disorders except acute myocardial infarction with cardiac catheter without MCC
• 458 — Spinal fusion except cervical with spinal curve, malign or 9+ fusions without CC
• 460 — Spinal fusion except cervical without MCC
• 470 — Major joint replacement or reattachment of lower extremity without MCC
• 490 — Back and neck procedures except spinal fusion with CC, MCC or disc device/neurostimulator
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