Significantly, the rationale the OIG gave for their determination of massive overpayment for neurostimulator claims was due to a lack of sufficient provider documentation that supported the medical necessity of the procedure. It should be noted that the March MLN advisory does not specify which neurostimulators codes are in view, stating only that the pre-authorization requirement applied to “implanted spinal neurostimulators.”Īccordingly, we recommend that those providers performing any implanted spinal neurostimulator service in the outpatient hospital setting contact their Medicare carrier prior to the service to determine if a pre-authorization is needed and, if so, to obtain such when these services are being planned for a Medicare patient. Apparently, the March 2022 MLN is CMS’s way of advising that these services are now back on the list.
#Papers please passport generator generator#
According to a document linked within the MLN article, the spinal neurostimulator implantation codes (CPT 63685 – insertion or replacement of spinal neurostimulator pulse generator or receiver, and CPT 63688 – revision or removal of implanted spinal neurostimulator pulse generator or receiver) had been temporarily removed from the pre-authorization list last year. Inexplicably, the MLN article says the ruling applies to services going back to July 1 of last year. The new ruling was published in a Medicare Learning Network (MLN) article earlier this month. As a result, the Centers for Medicare and Medicaid Services (CMS) issued a ruling that providers wishing to bill for implanted spinal neurostimulator services “in the hospital outpatient department” would first need to obtain authorization from their individual Medicare administrative contractor (MAC). Department of Health and Human Services (HHS) presented a finding that the government had overpaid on implanted neurostimulator claims by $636 million. In October of last year, the Office of Inspector General (OIG) of the U.S. As a follow-up, this may be a good time to alert those anesthesia groups who either have, or are thinking about installing, a chronic pain element to their range of services that there is a relatively new requirement that Medicare has imposed regarding a key chronic pain procedure. In last week’s article, we addressed chronic pain components within an anesthesia practice. It turns out that Medicare is now requiring greater attention to paperwork when it comes to a certain pain-related service. You just can’t get around it: insurance companies will often force you to dot every “i” and cross every “t” from a medical record perspective in order to get paid.
Your papers were not in order! As a result, the word “denied” now appears prominently on the EOB.
You’ve provided expert care to a patient in need you’ve documented the service in the manner you deemed appropriate but then you get a notification from the payer that your documentation didn’t meet their criteria. Many in the medical provider community can occasionally relate to the angst portrayed in the above scene. After a few seconds, he hears to his horror the dreaded words from the KGB enforcer: “Your papers are not in order.” He is approached by a representative of the feared KGB, who demands: “Your papers, please.” Nervously, the American hands his passport and other identifying documents over. In the Cold War spy thriller, Firefox, Clint Eastwood’s character is in the Soviet Union on a clandestine mission for the American government.
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