Length: 32 minutes
The treatment of varicose veins, in your office or in a hospital outpatient department, is subject to detailed and ever changing coverage policies. These policies, referred to by Medicare as a local carrier determination (LCD), and by private payors as a medical policy, establish medical necessity criteria that must be met before a patients surgical treatment will be reimbursed. Non-compliance to these published criteria can have disastrous results and can put your practice at significant financial risk. One vein practice was audited and, as a result, received a recoupment demand for $900,000 for failure to meet coverage criteria. This is just one of many scenarios where vein practices were obligated to repay a payor for not following medical coverage policies. Establishing a best practice approach to guide compliance with these coverage policies is an essential part of any vein practice.
In this 32-minute program, you'll learn:
What makes a vein practice an audit target?
The audit environment: who are the payor players and how do they impact you?
The definition of coverage policies/medical necessity policies and where to find them.
Components of varicose vein coverage policies.
How to document compliance in office visit, ultrasound, and varicose vein procedure notes.
How to prioritize your practice's compliance efforts.
Best practice procedures for ongoing policy compliance.
Why internal and external auditing are essential to compliance efforts
Tips for developing and executing a compliance plan.