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How to Protect Orthopedics

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Ciara Lewin

How to protect orthopedics in Fraud, Waste and Abuse. Knowing what CMS and payers are doing to target ortho providers and surgeons.

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Whether you are using Dragon, Transcriptionists, highly sophisticated EHR or still charting on your own, your medical necessity documentation must be fool-proof. HOW TO PROTECT ORTHOPEDICS IN FRAUD, WASTE & ABUSE Since 2018, CMS has had additional focus on orthopedics surgeons to better align quality measurements and improvement priorities. This still does not negate the resources used in detecting FWA for these measures. With less than 30 days left in this reporting period, now is the time to validate accuracy. Common documentation and coding errors have been found in these quality measures: #459 Back Pain Post Lumbar Disectomy/Laminotomy, #460 Back Pain Post Lumbar Fusion and #470 Change in Functional Status Post Total Knee Replacement Surgery Watch Your Bundles After seeing Coordinated Health's $12.5 million settlement due to -59 modifier, it is imperative you watch your surgery bundles. This is a high risk and will cost you millions if not done properly. Payers including Medicare has automation to check inconsistent and improper -59 modifier surgeries. Unless you too are using complex algorithms for quality assessment, you are at risk. Hip and Knee Replacement procedures are still amongst the highest error rate for reimbursement. If you don't want to do a full audit on all your 2019 surgeries, at least do a quick sample on these. Keep Them Out of Your Pockets Knowing that CMS has and will continue to perform audits for medical necessity and insufficient documentation, keep them away from your money! Take a few moments to have an experienced clinical and business expert review your documentation, give your guidance on gaps and help you keep what is yours. Quality Payments Programs Only relying on your team of coders is not enough anymore, no matter how experienced they are. CMS recouped $2.3 BILLION last year in their FWA efforts... and they aren't stopping. For 2020 it has already been announced that CMS will be reviewing accuracy of specific diagnosis codes. This include medical documentation to support diagnosis given. Stay Informed. Stay Alert. Stay Connected. www.eliteprecisionconsulting.com

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How to Protect Orthopedics

  • 1. Whether you are using Dragon, Transcriptionists, highly sophisticated EHR or still charting on your own, your medical necessity documentation must be fool-proof. HOW TO PROTECT ORTHOPEDICS IN FRAUD, WASTE & ABUSE Since 2018, CMS has had additional focus on orthopedics surgeons to better align quality measurements and improvement priorities. This still does not negate the resources used in detecting FWA for these measures. With less than 30 days left in this reporting period, now is the time to validate accuracy. Common documentation and coding errors have been found in these quality measures: #459 Back Pain Post Lumbar Disectomy/Laminotomy, #460 Back Pain Post Lumbar Fusion and #470 Change in Functional Status Post Total Knee Replacement Surgery Watch Your Bundles After seeing Coordinated Health's $12.5 million settlement due to -59 modifier, it is imperative you watch your surgery bundles. This is a high risk and will cost you millions if not done properly. Payers including Medicare has automation to check inconsistent and improper -59 modifier surgeries. Unless you too are using complex algorithms for quality assessment, you are at risk. Hip and Knee Replacement procedures are still amongst the highest error rate for reimbursement. If you don't want to do a full audit on all your 2019 surgeries, at least do a quick sample on these. Keep Them Out of Your Pockets Knowing that CMS has and will continue to perform audits for medical necessity and insufficient documentation, keep them away from your money! Take a few moments to have an experienced clinical and business expert review your documentation, give your guidance on gaps and help you keep what is yours. Quality Payments Programs Only relying on your team of coders is not enough anymore, no matter how experienced they are. CMS recouped $2.3 BILLION last year in their FWA efforts... and they aren't stopping. For 2020 it has already been announced that CMS will be reviewing accuracy of specific diagnosis codes. This include medical documentation to support diagnosis given. Stay Informed. Stay Alert. Stay Connected. www.eliteprecisionconsulting.com