Medicare contractors are now conducting pre- and post-payment reviews of joint replacements and are looking for providers to prove all other more conservative treatments were exhausted before proceeding to surgery.
Spinal fusion has also been added to the Program for Evaluating Payment Patterns Electronic Report’s list of risk areas. Studies have shown a 15-times increase in fusions from 2002 to 2007.
Experts suggest adding more details to documentation to prove necessity for a procedure, as well as making sure coders understand the technologies surgeons are using to make sure the codes accurately reflect such.
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At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.