DecisionHealth, DecisionHealth - 2012 Issue 9 (September)

MACs target joint surgeries; strengthen hospital notes of prior treatment

 

Survive widespread audits of total joint replacement claims by bolstering documentation of each patient’s previously unsuccessful treatments that lead to the surgery, and make sure those notes are in the hospital’s records. One Medicare administrative contractor (MAC), TrailBlazer, denied almost 74% of a sample of claims worth $5.2 million for DRG 470 (Major joint replacement or reattachment of lower extremity without major complication/comorbidity) between July 2010 and March 2011.

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