Provide Healthcare, Get Investigated?
When I started medical school, if someone had told me that providing healthcare to my patients would be grounds for a Department of Justice inquiry into the care I delivered, I would have laughed in their face. But the government’s desperate financial times require desperate measures. From the Report on Medicare Compliance:
Both the Department of Justice (DOJ) and the Recovery Audit Contractors (RAC) are focusing investigations on Medicare billing for implantable cardiac defibrillator (ICD) surgery. The reimbursement rate for ICD surgery is one of the higher dollar Medicare Severity Diagnosis Related Groupings (MS-DRG). The DOJ’s investigation is focusing on both medical necessity and MS-DRG coding validation issues, while the RACs are currently only conducting MS-DRG validation reviews. According to the CMS national coverage determination (NCD), Medicare pays for ICD implantation for eight specific conditions. However, there are many circumstantial limitations to coverage in these conditions that often lead to CMS not covering the implantation. Read more »
*This blog post was originally published at Dr. Wes*