RAC Region C contractor Connolly posted 2 automated reviews for DME providers on April 8, 2014, regarding Mechanical In-exsufflation Devices, High Frequency Chest Wall Oscillation Devices, and Urological Supplies. Per the contractor’s description of these issues, overpayments were identified where ICD-9-CM coding was not in accordance with billing requirements outlined in Local Coverage Determinations (LCD) for DME devices. Mechanical In-Exsufflation HCPCS CODES Group  ...

RAC Region B contractor CGI posted a semi-automated review on March 26, 2014, for outpatient providers regarding the medical necessity for the drug Cetuximab. Per the contractor’s description of this issue,  clinical editing to identify potential incorrect billing occurring for Cetuximab claims billed with an ICD-9-CM code that does not support medical necessity, according to existing Medicare policy, FDA labeling, accepted guidelines, approved compendia, or other Medicare rules and ...

The number of spinal surgeries done in the U.S. has increased in a recent 10 year period by 137%. And the national bill for those surgeries has increased by almost 8 times. This trend has not gone unnoticed by payers.   Lumbar spinal fusion surgeries in particular have been focused on as a target for cost savings. There are conflicting reports as to whether these surgeries are always necessary, whether less invasive therapies can be employed before resorting to surgery, or whether spinal ...