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HealthDataInsights welcomes you to RAC-Info!
Please take note of HealthDataInsights' (HDI) new mailing address below:
HealthDataInsights, Inc.
9275 West Russell Road, Ste. 100
Las Vegas, Nevada 89148

Important Provider Updates

05/29/2015:   Part A Post Payment “$3700 Therapy Threshold” Reviews ADR Request
HDI recently released ADR letters for the Part A Post Payment $3700 Therapy Threshold review. A copy of the current state license, diploma or National Provider Identifier number (NPIN) of therapist performing services is not required. Please submit all other requested documentation to support the therapy services rendered. The Post Payment $3700 Therapy Threshold reviews are mandated by Congress and do not follow the CMS ADR limits or the ADR limits timeframe.

05/29/2015:   Additional CMS Approved Complex Reviews
Recovery Auditors have received CMS approval to review a limited number of additional Complex Reviews.

New Issue Number New Issue Description
D000572011 Skilled Nursing Facility - Medical Necessity
D001452012 Incorrect Billed Drug and Biological HCPCS Code - Prof.Services
D001462012 Incorrect Billed Drug and Biological HCPCS Code - Outpatient
D001502012 Incorrect Billed Drug and Biological HCPCS Code - Underpayment - Prof.Services
D001512012 Incorrect Billed Drug and Biological HCPCS Code - Underpayment - Outpatient

For your convenience you may click on the New Issues link above to review the list of all Region D CMS Approved New Issues.

01/16/2015:   Part A Post Payment “$3700 Therapy Threshold” Reviews
Recovery Auditors have received CMS approval to review Part A Post Payment Therapy claims, from 2014, that are over the $3700 threshold.

12/31/2014:   Recovery Auditor Program Extension
CMS has approved an extension of the Recovery Auditor Program.

10/24/2014:   MS-DRG Validation "Underpayments" Reviews
Recovery Auditors have received approval from CMS to begin MS DRG Validation “Underpayment” reviews as of October 24th, 2014. For your convenience you may click on the New Issues link above to review the list of all Region D CMS Approved New Issues.

10/14/2014:   Additional CMS Approved Complex New Issues
Recovery Auditors have received approval from CMS to immediately begin complex coding review for “Excessive Drug Units Billed” and “Insufficient Drug Units Billed”. “Insufficient Drug Units Billed” is the first “underpayment” review approved for Recovery Auditor review during the contract modification. As a result, HDI will begin sending Additional Documentation Requests (ADRs) to providers for these reviews within the upcoming weeks.

9/26/2014:   Recovery Auditor Contract Modification
Recovery Auditors have received approval from CMS to begin automated reviews as of August 27, 2014. In addition, the Recovery Auditors have received approval from CMS to begin DRG Validation Reviews as of September 8th, 2014. The Recovery Auditors will immediately begin reviewing all of the CMS previously approved Automated and DRG Validation Review New Issues.

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