July 23, 2012
Inpatient Service Specific Review of Short Stays Diagnosis Related Group (DRG) for Percutaneous Cardiovascular Procedure without Coronary Artery Stent without MCC (DRG 251)
The J15 Part A Medical Review department will be performing a service-specific probe review on inpatient services for short stays for Percutaneous Cardiovascular Procedure without Coronary Artery Stent without MCC. Claims review will be performed on approximately 100 claims per state for DRG 251 in Kentucky and Ohio.
Providers who receive an Additional Documentation Request (ADR) must submit the requested medical record information within 30 days to:
CGS
J15 Part A Medical Review
Mail Code AG-256
P.O. Box 100140
Columbia, SC 29202-3140
Please mail the medical records to the following address if you are using FedEx or UPS overnight service:
CGS
J15 Part A Medical Review
Mail Code AG-256
2300 Springdale Drive, Building One
Camden, SC 29020
Or Fax to (803) 462-2592 (Use the ADR letter as a cover sheet).
Providers should ensure the accuracy of their billing and send the following documentation when responding to the ADRs:
- Physician's orders for the admission and all services billed
- Itemized List of All charges
- Hospital Admission Assessment and hospital discharge summary
- Hospital History and Physical
- Physician progress notes
- Consultation Reports
- Plan of Care
- Diagnostic Test results/reports, including imaging reports
- Clinical/therapy notes
- Please submit all documentation to support the medical necessity of services billed and the DRG code billed
- A signature log or an attestation statement, if you question the legibility of your signature. Medicare Requires that medical records entries for services provided/ordered is authenticated by the author. The method used shall be a hand written or electronic signature. Stamp signatures are not acceptable. Patient identification, date of service and provider of the service should be clearly identified on the submitted documentation.
Completed review results will be posted at www.cgsmedicare.com/parta. Individual providers with significant denials will be contacted for one-on-one education.
Questions regarding the short stay inpatient reviews can be directed to the Medical Review department at (803) 763-4999.
