Newly approved Recovery Auditor issues – 05/25/2016

May 25, 2016
Medicare Insider

HDI posts one new issue in one category

HealthDataInsights (HDI) posted one new issue in one category to its CMS list for providers in Region D. (See link for individual state applicability.)

According to the HDI website, the new issue is:

For outpatient hospitals:

  • Complex review of Polysomnography and Sleep Studies– Outpatient. When the documentation does not meet the criteria for the service rendered or the documentation does not establish the medical necessity for the services, such services will be denied as not reasonable and necessary. Diagnostic testing that is duplicative of previous testing done by the attending physician to the extent the results are still pertinent is not covered because it is not reasonable and necessary under 1862(a)(1)(A) or the ACT
Related Topics: 
Recovery auditors