tci Medicare Compliance & Reimbursement - 2014 Issue 7

Denial Management: Refresh Documentation Know-How for Total Joint Replacements -- or Risk Claim Denials

Dodge denial code 5J504 (Need for service/item not medically and reasonably necessary). A new wave of audits may threaten claims for total joint replacement (TJR) procedures in 2014, at least for physicians and hospitals who fail to revisit existing guidelines for documenting medical necessity for DRG 470. Background: In 2011, MACS and then RACs began auditing and denying numerous claims for procedures including lower-extremity TJRs, after prepayment probes and other audits revealed that providers failed to make an adequate case for the medical necessity of the expensive procedures.  Recently, recovery auditor Connolly Inc. added to its CMS Approved...

To read the full article, sign in and subscribe to tci Medicare Compliance & Reimbursement.


Keep pace with evolving Medicare regulations — and onboard your team — with timely analysis of critical updates interpreted in an easy-to-follow, easy-to-apply format. Your subscription to TCI's Medicare Compliance & Reimbursement Alert will equip you to navigate code and guideline changes, CCI edits, and revisions to modifiers, payer policies, the fee schedule, OIG target areas, and more.

  • Current newsletters added each month
  • Fully searchable archives - over 4200 articles
  • ALL years/issues back to 2003 organized by year and issue
  • Codes mentioned in articles are linked to Code Information pages
  • Code Information pages link back to related articles
Access to this feature is available in the following products:
  • tci Medicare Compliance & Reimbursement +Archives

demo
request yours today
 subscribe
start today
 newsletter
free subscription

Thank you for choosing Find-A-Code, please Sign In to remove ads.