March 28th, 2011 by DrWes in Health Policy
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In case people are wondering if our governmental overlords really care about the latest and greatest treatment guidelines published by our professional health care organizations, take note.
CMS (Center for Medicare and Medicaid Services) is still using guidelines for defibrillator implantation from 2005 to justify payment for services in their national coverage decision, whereas the latest guidelines published by the Heart Rhythm Society published in 2008 carry signficiant differences in their recommendations for appropriate patients for this technology.
So which set of guidelines should doctors use?
The answer is obvious: if you use the latest data to decide who should receive a defibrillator, you might be subject to a Department of Justice investigation.
So much for using updated guidelines.
-WesMusings of a cardiologist and cardiac electrophysiologist.
*This blog post was originally published at Dr. Wes*
June 7th, 2010 by DrWes in Better Health Network, Health Policy, Opinion
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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*