RAC expands 5 targets to Florida physicians

Florida providers will now be subject to five, CMS-approved Recovery Audit Contractor (RAC) issues, Connolly Healthcare says. Connolly previously announced seven targets aimed at providers in South Carolina, five of which now apply to Florida.

Those targets are:

1. Untimed codes (excluding modifiers KX, specific required documentation on file; and, 59, distinct medical service) where the procedure is not defined by a specific timeframe. The provider should have entered a one in the units billed column per date of service. 
2. IV Hydration therapy based on definition of 90760 (excluding claims modifier 59), the maximum number of units should be one per patient per date of service. NOTE: Beginning Jan. 1, code 90760 was replaced with 96360 (IV infusion, hydration initial 31 minutes to 1 hour, $56.62).
3. Once in a lifetime procedures by virtue of the description of the CPT code, these codes can be performed only once during the patient's lifetime.
4. Pediatric codes exceeding age parameters, newborn/pediatric CPT codes being applied/billed for patients exceeding the age limit defined by the code.
5. J2505 (injection, Pegfilgrastim, 6 mg) the code should be billed at one unit per patient per date of service.

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