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Total Knee Arthroplasty: The Status Controversy Continues

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The status of TKA patients continues to be perilous for facilities and providers. In a vacuum of regulatory ambiguity audits metastasize. Learn to avoid RAC audits and huge takebacks for failing to place TKA patients in the correct status.

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Product Code: AR040419


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Description Biography
 

The Centers for Medicare & Medicaid Services (CMS) removed total knee arthroplasty from the inpatient-only list in January 2018 and did so with little practical guidance in how to make a status determination.

In fact, CMS asked professional societies and hospitals to develop their own guidelines. Yet when those guidelines were presented to CMS, they were often rejected. The 2018 Outpatient Prospective Payment System (OPPS) Final Rule provided CMS' official guidance yet much of it was written in general terms with no specifics.

In an attempt to ease worries, CMS also prohibited the Recovery Audit Contractors (RACs) from auditing these cases for two years. But that prohibition did not stop the Quality Improvement Organizations (QIOs) from pulling one-day stays as part of the short inpatient admission probe and educate program, with anecdotal evidence suggesting the majority of these were denied.

The main fallout of this confusion lands on the hospitals and physicians who are participating in bundled payment programs, as those programs only encompass inpatient admissions and the shift of many patients from inpatient to outpatient is having negative consequences on the success of their programs.

In this webcast, Dr. Hirsch will review CMS guidance, review the professional society's position statements, review the QIO audit process and will provide a compliant, workable solution to ensure that all patients are placed in the correct status with the best chance of success if audited.

Why This is Relevant:

Here are just a few of the many reasons why this exclusive RACmonitor webcast is so timely and relevant:

  • One-day admissions are being actively audited and a denial on a total knee admission can be the straw that sends the hospital on to more audits or even a referral to the RAC;
  • Because physicians in bundled payment programs only get to share savings from total knee inpatient admissions, they may choose to stretch the rules to admit patients inappropriately, leading to a compliance issue; and
  • Case managers are often tasked with guiding physicians to the correct status; if they learn how to properly determine the status, they can be the guide for the physicians.

Learning Objectives:

By attending this webcast led by Dr. Hirsch on TKA, you will…

  • Understand the changes to the inpatient only list effective on Jan. 1, 2018;
  • Learn how to develop a plan to analyze the implication of the list changes to each facility;
  • Know how to develop a framework for determining the proper admission status of patients undergoing total knee replacements; and
  • Benefit from a review the criteria used by CMS for placing surgeries on the inpatient only list and removing them.

Who Should Attend:

Nurses, physicians, physician advisors, chief financial officers, RAC coordinators, compliance professionals, case managers, UR staff, chief medical officers, social workers, and revenue integrity and revenue cycle specialists.