by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Mar 31st, 2022
According to the OIG "MEDICARE OVERPAID MORE THAN $636 MILLION FOR NEUROSTIMULATOR IMPLANTATION SURGERIES."
So often we think if we get paid, we must be doing it right, well this is not always the case. You may get paid and then have to return the funds if billed incorrectly or a step was missing from your compliance plan.
Do you have a compliance plan when it comes to claims processing? If not, I suggest you get it started. If you do, it is important to review it often to ensure there is nothing missing. To get started, take a look at your highest-paid claims, or highest volume and start there. Be sure there are processes at each step of the way, from the first phone call before the patient is seen to the last visit. In the case of neurostimulators, CMS has information on what is needed in the medical record to avoid take-backs.
CMS reported, "In a recent report, the Office of Inspector General found that Medicare improperly paid claims for implanted spinal neurostimulators when providers didn’t provide sufficient documentation supporting medical necessity. For dates of service on or after July 1, 2021, you must ask your Medicare Administrative Contractor to authorize these services before performing the procedure in the hospital outpatient department."
Implanted Spinal Neurostimulators: Document Medical Records
Learn what you need to include in-inpatient medical records:
- Prior Authorization and Pre-Claim Review Initiatives webpage
- Section XVII Calendar Year 2021 Hospital Outpatient Prospective Payment System final rule
- Section 184.108.40.206 Prior Authorization Program for Certain Hospital Outpatient Department Services (PDF) operational guide
- 2021 Final List of Outpatient Department Services That Require Prior Authorization (PDF)
About Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Christine Woolstenhulme, CPC, QCC, CMCS, CMRS, is a Certified coder and Medical Biller currently employed with Find-A-Code. Bringing over 30 years of insight, business knowledge, and innovation to the healthcare industry. Establishing a successful Medical Billing Company from 1994 to 2015, during this time, Christine has had the opportunity to learn all aspects of revenue cycle management while working with independent practitioners and in clinic settings. Christine was a VAR for AltaPoint EHR software sales, along with management positions and medical practice consulting. Understanding the complete patient engagement cycle and developing efficient processes to coordinate teams ensuring best practice standards in healthcare. Working with payers on coding and interpreting ACA policies according to state benchmarks and insurance filings and implementing company procedures and policies to coordinate teams and payer benefits.