“Finally Friday!” Can You Get Medicare to Pay for Surgery Prep?

Is Gray the New Black?

Can You Get Medicare to Pay for Surgery Prep?

Watch the Replay and Get the Handouts

The Tyranny of Choices - what to do, what to do...

The Tyranny of Choices – what to do, what to do…

Since there was a lot of discussion this week on the rac-relief Google Group about how to handle cases where a patient simply cannot do needed surgery prep on their own, and what to do if you admit them to the hospital to have this done, and then can you get paid for it, we asked Dr. Ronald Hirsch of Accretive Health to give us his viewpoint and suggestions. We also asked our Audit expert, Bill Malm of Craneware to be on hand as well, to talk about how this might play with the auditors. That is, what would the auditors want to see to approve such a claim for payment?

So here’s what covered on the show:

  • When is Surgery Prep appropriate as “hospital services”?
  • When is Surgery Prep arguably “medically necessary” – for payment purposes?
  • When can a procedure not on the Inpatient-Only List be paid as Inpatient?
  • What would an Auditor want to see to approve such a bill?…and in case we’re feeling clairvoiant…
  • What might the RAC and/or MAC do with all that?

We also reviewed a CERT powerpoint presentation that kind of explained some of CMS’s thinking on all this…  find that and more in the handouts, plus get to watch the recording, below.

Video Replay & Handouts

This week’s handouts include:

References from 8-22 Show [Word doc]
Transmittal 1422
Medicare FFS 2013 Improper Payments Report
3x PDFs about Surgery Prep for Mechanical Bowl
CERT 101 July 2013 by CMS [SLIDES]


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