Come January 1, 2020, the healthcare industry will most likely find itself in another state of frustration. That is when the 2020 Outpatient Prospective Payment System (OPPS) final rule is expected to decree that total hip arthroplasty (THA) will be removed from the inpatient-only list. And, as with the case when total knee arthroplasty (TKA) was removed from the inpatient-only list, organizations are once again challenged by how best to decide status for patients undergoing these surgeries
Dating back to TKA removal from the inpatient-only list two years ago until now with the same decision regarding THA, there has been little detailed guidance from the Centers for Medicare & Medicaid Services (CMS) regarding status decisions. Recovery Audit Contractors (RACs) have been prevented from auditing TKA cases and the Quality Improvement Organizations (QIOs) have been randomly reviewing TKA cases as part of the Targeted Probe and Educate (TPE) plan.
With little guidance to start and scattered anecdotal review feedback at best, many hospitals have continued to feel they are making process decisions very subjectively. It has been a delicate and painful dance to balance the demands of disgruntled orthopedic surgeons, patients, and families, who misunderstand medically necessary care, with the prudent desire for compliance, and reasonable goals to capture deserved revenue.
In this webcast, Dr. Banker will review CMS guidance, the QIO audit process and viable solutions for status determination based on available guidance, patient characteristics, and organizational capabilities. In short, no solution is one size fits all!
Why This is Relevant:
THA represents a potential revenue loss as well as increased audit scrutiny as many stakeholders, including physicians and patients, grapple with medical necessity issues since THA will become an outpatient procedure.
During this RACmonitor webcast, led by Dr. Banker, you and your team will…
- Understand the changes to the inpatient-only list regarding THA;
- Become familiarized with current relevant CMS guidance and specialty society thoughts;
- Learn how to develop a plan to analyze the impact of this change for your organization; and
- Consider various solutions designed to most effectively determine the proper admission status for patients undergoing THA, especially with regard to your unique organizational circumstances.
Who Should Attend:
Those who will gain the most from this webcast include RAC coordinators, compliance professionals, case managers, UR staff, nurses, physicians, physician advisors, chief financial officers, chief medical officers, social workers, and revenue integrity and revenue cycle specialists.