On Becker's Healthcare Ambulatory Surgery Centers Podcast, Jennifer Weaver discusses the risks of miscoding today's spine and orthopedic procedures. Becker's Healthcare ASC Podcast is a new podcast from Becker's Healthcare that features interviews and conversations with thought leaders in ASC's on trending topics.
Jennifer's insights which she shares with Becker's come from her wealth of experience representing healthcare providers in their interactions with the government - helping handle audits, build compliance plans, and much more.
As Jennifer describes, "Whenever you are using a highly reimbursed code, the government takes notice." For example, Jennifer describes a pain management device that had great clinical outcomes, was low-cost to the provider, but was coded via a highly reimbursed code. However, as later clarification revealed, that code was only for surgically implanted devices, and this particular device did not require surgery.
The government noticed the spike in the use of the highly reimbursed code, and because the device was not surgically implanted, CMS came back with lawsuits across the country for all of the providers that had used that code, many of which had to pay multimillion dollar settlements.
So, Jennifer's advice to clients is, "If it seems too good to be true, it probably is." This rings true for any coding practice, and caution should be used when determining how to code different procedures and services.
To learn more about the importance of proper coding and more, listen to the full podcast episode here.
More information is also available in this article from Becker's.
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