Medicare Audit

Panacea Financial Contract Review
This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
Advertisement - Members don't see this ad
besides the fact that that is a template, even though you mention template...

id suggest, if you have Epic, just putting in some @@ phrases, so it looks less like you did 1 click for the template. talking to one P2P doc, he told me whenever he sees a template, he thinks the doc is essentially a needle jockey. he stated he appreciated details in the request - date i saw him, the starting pain and resultant reduction, patients name in the template.
 
Ducttape said:
besides the fact that that is a template, even though you mention template...

id suggest, if you have Epic, just putting in some @@ phrases, so it looks less like you did 1 click for the template. talking to one P2P doc, he told me whenever he sees a template, he thinks the doc is essentially a needle jockey. he stated he appreciated details in the request - date i saw him, the starting pain and resultant reduction, patients name in the template.
Click to expand...

So the P2P doc likes it when you part his buttocks one at a time, squeezing the right just slightly before pressing the left side away, allowing breeze to gently woft across his anus before you start kissing it. He really likes it when you use say his first name in between licks. Anytime a doctor doesn't do this to him, he immediately assumes they're just 'hookers' who don't really care whose butt their lips are on. Sounds like someone I'd call a colleague and friend.
 
Ducttape said:
besides the fact that that is a template, even though you mention template...

id suggest, if you have Epic, just putting in some @@ phrases, so it looks less like you did 1 click for the template. talking to one P2P doc, he told me whenever he sees a template, he thinks the doc is essentially a needle jockey. he stated he appreciated details in the request - date i saw him, the starting pain and resultant reduction, patients name in the template.
Click to expand...
Great idea. So for those of us who pay a transcription service our costs double I guess? Add another 5 paragraphs of BS.
 
buddababa said:
may have to switch to cash only practice and re-use needles like they do in 3rd world countries - sad.
Click to expand...
Our pain profession has two cohorts : the fat cats (gen X) and the foot soldiers (millennials) . The future of medicine will be interesting.
 
powermd said:
My updated CMS MBB BS verbiage:

Patient meets CMS criteria for facet joint treatment: 1) Pain is rated NRS>6 (moderate to severe), 2) Pain > 3 months, 3) Pain has not responded to more conservative care options as documented in this note and/or the patient's original consult note, 4) Radiculopathy or neurogenic claudication, if present, has been treated, 5) There is no other known cause of the patient's axial pain (such as fracture, tumor, infection, or significant deformity), 6) Pain was assessed at baseline, and is assessed following diagnostic medial branch blocks using the same scale asking patients to rate their subjective % pain relief attributable to the procedure. 7) Notes are all signed electronically when closed using our Athena EHR system. 8) No steroid is used in any of our medial branch block procedures ever. 9) No "region" defined as cervical, thoracic, or lumbar is ever treated with RFA more than once in a six-month period. 10) Medications and concentrations are documented in procedure notes. 11) ALL facet interventions in this clinic are performed with fluoroscopic guidance, 12) Although templates are used to demonstrate that treatment conforms to CMS requirements, each patient's care is highly individualized. 13) "Function" was assessed at baseline using the Oswestry questionnaire. 14) "Confirmatory" medial branch blocks are only performed if patient reported subjective pain relief is sustained at 80% or greater for the approximate duration of action of the agent used (for bupivacaine 0.25%, this is 4-6 hours; for lidocaine 2%, this is 1-2 hours). 15) Dr. Powermd is qualified to perform the procedure consistent with CMS requirements having ABA board certification in anesthesiology with ABA subspecialty certification in pain medicine.

Anything missing?
Click to expand...
you're a god among us
 
10KHertz said:
Our pain profession has two cohorts : the fat cats (gen X) and the foot soldiers (millennials) . The future of medicine will be interesting.
Click to expand...
I’m gen x and I’m no fat cat
 
powermd said:
So the P2P doc likes it when you part his buttocks one at a time, squeezing the right just slightly before pressing the left side away, allowing breeze to gently woft across his anus before you start kissing it. He really likes it when you use say his first name in between licks. Anytime a doctor doesn't do this to him, he immediately assumes they're just 'hookers' who don't really care whose butt their lips are on. Sounds like someone I'd call a colleague and friend.
Click to expand...

Hahahaha yes please
 
powermd said:
So the P2P doc likes it when you part his buttocks one at a time, squeezing the right just slightly before pressing the left side away, allowing breeze to gently woft across his anus before you start kissing it. He really likes it when you use say his first name in between licks. Anytime a doctor doesn't do this to him, he immediately assumes they're just 'hookers' who don't really care whose butt their lips are on. Sounds like someone I'd call a colleague and friend.
Click to expand...
if it gets the procedure approved and doesnt take any extra time, then it has to be done.

10KHertz said:
Our pain profession has two cohorts : the fat cats (gen X) and the foot soldiers (millennials) . The future of medicine will be interesting.
Click to expand...
you forgot the anachronistic dinosaurs (baby boomers).

we arent all out the door... yet.
 
MitchLevi said:
Great idea. So for those of us who pay a transcription service our costs double I guess? Add another 5 paragraphs of BS.
Click to expand...

Suddenly I'm reminded of the internet's dark ages when people would complain about the extended signatures others would use on their listserv posts because they were paying for dial up service by the kilobyte.
 
Advertisement - Members don't see this ad
powermd said:
Suddenly I'm reminded of the internet's dark ages when people would complain about the extended signatures others would use on their listserv posts because they were paying for dial up service by the kilobyte.
Click to expand...
Totally.
 
powermd said:
Suddenly I'm reminded of the internet's dark ages when people would complain about the extended signatures others would use on their listserv posts because they were paying for dial up service by the kilobyte.
Click to expand...

im sure that is something the Sysop will be able to address.....
 
Are you guys trying to stroll down a childhood memory lane from the 80s?


1655214450012.png
 
So I resent all the documents, procedure notes , previous failed therapy etc. It was an hour long discussion on why there was a statement “ Similarly the procedure was repeated on the other side”

I’m fighting them tooth and nail for this. They did not come up with anything substantial. Waiting for 60 days to hear back from them.

Apparently, you have an option of doing a level 2 appeal and then go to an administrative law judge if you want to continue fighting this.

I’m getting tired of this BS.
 
bronchospasm said:
So I resent all the documents, procedure notes , previous failed therapy etc. It was an hour long discussion on why there was a statement “ Similarly the procedure was repeated on the other side”

I’m fighting them tooth and nail for this. They did not come up with anything substantial. Waiting for 60 days to hear back from them.

Apparently, you have an option of doing a level 2 appeal and then go to an administrative law judge if you want to continue fighting this.

I’m getting tired of this BS.
Click to expand...

So they want a completely separate discussion for the opposite side of an injection procedure? Got it. I'll add that nonsense to my list of template updates.
 
bronchospasm said:
So I resent all the documents, procedure notes , previous failed therapy etc. It was an hour long discussion on why there was a statement “ Similarly the procedure was repeated on the other side”

I’m fighting them tooth and nail for this. They did not come up with anything substantial. Waiting for 60 days to hear back from them.

Apparently, you have an option of doing a level 2 appeal and then go to an administrative law judge if you want to continue fighting this.

I’m getting tired of this BS.
Click to expand...
my hospital isn't fighting it and they're paying back all the money. - if they come after my money, then i'll be upset. Its their fault that they fired pre-cert people to save money and the replacements had no idea about lcd requirements
 
I’ve never seen an LCD requirement about note documentation/bilateral commentary? Can someone direct me to this?
 
Is anyone getting rich off of Medicare facets? They’ve squeezed the reimbursement down to drops, what’s even left to audit and recoup at this point…
 
Advertisement - Members don't see this ad
Not sure if this is what you're referring to but I write out the whole procedure in detail for each MB, each side. Not "procedure was repeated on the other side". A consultant said that doesn't fly.
 
did you use the -50 modifier or the -lt/-rt modifiers?

following up on what Rolo said, i think if you used left right modifiers and did not specifically document separate part of your note on the other side, it may have triggered the audit....
 
RoloTomassi said:
Not sure if this is what you're referring to but I write out the whole procedure in detail for each MB, each side. Not "procedure was repeated on the other side". A consultant said that doesn't fly.
Click to expand...
I’m pretty annoyed that I was specifically taught to write that exact statement, but better late than never hopefully. Thanks very much for this insight.
 
Dealing with paid RAC auditors is like dealing with the communist Democratic Party. Now Biden wants 87k armed IRS auditors to harass hardworking folks. This country is going to ****…

I mentioned years ago Blue cross was coming after “b/l” vs right and left , now
Medicare is using the same nonsense playbook.

All I can offer is that everybody needs to fight these auditors to the max possible sessions , until we get a real president/administration that cares about doctors and small businesses…
 
10KHertz said:
Dealing with paid RAC auditors is like dealing with the communist Democratic Party. Now Biden wants 87k armed IRS auditors to harass hardworking folks. This country is going to ****…

I mentioned years ago Blue cross was coming after “b/l” vs right and left , now
Medicare is using the same nonsense playbook.

All I can offer is that everybody needs to fight these auditors to the max possible sessions , until we get a real president/administration that cares about doctors and small businesses…
Click to expand...

Do you mean that you feel like Medicare is headed toward ceasing reimbursement of bilateral procedures? Or just referring to the documentation?
 
Drd105 said:
Do you mean that you feel like Medicare is headed toward ceasing reimbursement of bilateral procedures? Or just referring to the documentation?
Click to expand...
Medicare is discouraging unilateral levels , forcing less bilateral levels, and then retracting b/l procedure reimbursement, for bull**** documentation policy , that they refuse to disclose after filing 2-3 appeals…
RAC audits are CMS goons authorize by this presidential administration/CMS director to harass specialists and high volume providers . Esp ones that say f you to their quality measure nonsense …
 
10KHertz said:
Dealing with paid RAC auditors is like dealing with the communist Democratic Party. Now Biden wants 87k armed IRS auditors to harass hardworking folks. This country is going to ****…

I mentioned years ago Blue cross was coming after “b/l” vs right and left , now
Medicare is using the same nonsense playbook.

All I can offer is that everybody needs to fight these auditors to the max possible sessions , until we get a real president/administration that cares about doctors and small businesses…
Click to expand...
"When you see that in order to produce, you need to obtain permission from men who produce nothing....You may know that your society is doomed"

@SSdoc33 asked me to quote this for him from his favorite author.
 
Pain Applicant1 said:
"When you see that in order to produce, you need to obtain permission from men who produce nothing....You may know that your society is doomed"

@SSdoc33 asked me to quote this for him from his favorite author.
Click to expand...

at least I don't force my kids to chair the Ayn Rand Fan Club at their middle school.....
 
drusso said:
PM me and I and I can hook you up with free books and links to virtual peer lead discussion groups.

aynrand.org

Free Books High School - AynRand.org

aynrand.org aynrand.org
Click to expand...
thanks. im pretty sure i can find the fountainhead at the library. i will say, however, that it makes a great level for an uneven ladder or as kindling for campfires.

i actually think there is some worthwhile stuff in those books. it is those who take it as gospel that make me shrug my own atlas
 
Last edited:
Advertisement - Members don't see this ad
You must log in or register to reply here.

Similar threads

P
Uhc medicare advantage
Replies
0
Views
156
PinchandBurn
P
C
Medicare Telehealth extension
Replies
2
Views
667
CarabinerSD
C
M
Billing Audit Companies?
Replies
1
Views
699
BobBarker
BobBarker
SpineandWine
Medicare to stop audit on third and fourth level?
2
Replies
69
Views
5K
pmrmd
P
bedrock
Lyrica- Medicare
Replies
4
Views
1K
bedrock
bedrock
Top Bottom