News: Trailblazer to begin prepayment reviews for four cardiac-related procedures
December 22, 2011
CDI Strategies - Volume 5, Issue 27
Effective December 15, Trailblazer Health Enterprises, LLC, began prepay service-specific medical reviews of the following DRGs:
- DRG 227 (cardiac defibrillator implant without cardiac catheterization without major complications and comorbidities)
- DRG 251 (percutaneous cardiovascular procedure without coronary artery stent without major complications and comorbidities)
- DRG 253 (other vascular procedures with complications and comorbidities)
- DRG 254 (other vascular procedures without complications and comorbidities/major complications and comorbidities)
TrailBlazer is the Medicare Administrative Contractor (MAC) covering Part A and Part B payments for Colorado, New Mexico, Oklahoma, Texas, and the Indian Health Service. It encourages providers to “analyze internal data for compliance with coverage and coding guidelines and medical necessity requirements in accordance with Medicare policy.”
Furthermore, TrailBlazer recently announced that it will be comparing Part A (hospital) with Part B (physician) claims, looking for discrepancies between the two (read more about this in the upcoming January edition of The CDI Journal). The notice, Part A/B Cross-Claim Medical Review: The Impact It Will Have on Physicians, is located on the Trailblazer website.