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.
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 orthopedic and spine procedures:
• 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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