We have been informed of RAC activity in Region A (Performant Recovery, Inc.) for the following states: Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont.
RAC Issue in Region B (CGI) for the same issue (SNF Psychiatric Condition) is posted for the following states: Illinois, Minnesota, Wisconsin, Michigan, Indiana, Ohio, and Kentucky.
RAC Issue in Region C (Connolly) for the same issue (SNF Psychiatric Condition) is posted for the following states: Alabama, Arkansas, Colorado, Florida, Georgia Louisiana, Mississippi, North Carolina, New Mexico, Oklahoma, South Carolina, Tennessee, Texas, Virginia, West Virginia, and Territories of Puerto Rico and U.S. Virgin
The focus are patients with a psychiatric condition who transferred from a psychiatric hospital to a SNF.
Issue Title |
SNF Psychiatric Condition
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Number | A000602012 |
Description |
Patients with only a psychiatric condition who are transferred from a psychiatric hospital to a participating SNF are likely to receive only non-covered care. Also, patients whose primary condition/needs are psychiatric in nature often require considerably more specialized, sophisticated nursing techniques and physician attention than is available in most participating SNFs. (SNFs primarily engaged in treating psychiatric disorders are precluded by law from participating in Medicare.)
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Type of Review | Complex |
Provider Type | Skilled Nursing Facility |
States |
CT, DC, DE, MD, ME, MA, NY, PA, MD, NJ, RI, VT, NH
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Date of Service |
Claims having a “claim paid date” which is more than 3 years prior to the ADR date will be excluded.
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More Information | Click to view |
Issue Title |
Skilled Nursing Facility (SNF) Psychiatric Condition
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Number | |
Description |
Patients with only a psychiatric condition who are transferred from a psychiatric hospital to a participating SNF are likely to receive only non-covered care. Also, patients whose primary condition/needs are psychiatric in nature often require considerably more specialized, sophisticated nursing techniques and physician attention than is available in most participating SNFs. (SNFs primarily engaged in treating psychiatric disorders are precluded by law from participating in Medicare.)
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Type of Review | Complex |
Provider Type | SNF |
States |
MN, WI, MI, IL, IN, OH, KY
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Date of Service |
Dates of Service 10/1/2007–Open
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More Information | Click to view |
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