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.