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Connolly Consulting, the Medicare Recovery Audit Contractor (RAC) for Region C, identified on its website CMS-approved audit issues.

The following claims will be edited automatically and monies recouped in these areas if they were billed incorrectly:

  • Pegfilgastim claims not billed with the 6 mg unit of service (Florida, Georgia, South Carolina)
  • Newborn pediatric CPT codes billed for patients exceeding age limit
  • Once in a lifetime procedures (Florida, Georgia, South Carolina)
  • Excessive units - Untimed codes (Alabama, Florida, Georgia, South Carolina)
  • Excessive units - Blood transfusions (Alabama, Florida, Georgia, South Carolina)
  • Excessive units - Bronchoscopy
  • Excessive units - IV hydration (Alabama, Florida, Georgia, South Carolina)
  • CSWs billing during an inpatient stay (Florida Only)

Posted 9/17/09


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