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 patient’s 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.
About
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.
- Audits and Varicose Vein Treatment
- Coverage Policies and Documentation Imperatives
- Conservative Trial Highlights
- Establishing and Applying a Coverage Policy Compliance Process
Presenter
Teri Romano, RN, MBA, CPC, CMDP
Consultant and Speaker
Teri Romano has over twenty-five years of consulting and teaching experience in the health care field. Ms. Romano works with physician groups and hospitals combining a background in clinical systems with solid approaches to operational and organizational problem solving.
Find out about more about Teri Romano, RN, MBA, CPC, CMDP
Consultant and Speaker
