Letter highlights expertise in Medicare regulations and instructions; counsels cardiologists about critical reimbursement criteria
Ronald Hirsch, M.D., vice president of regulations and education at AccretivePAS®, recently had a letter to the editor published in JAMA (Journal of the American Medical Association) Internal Medicine. In the letter, Dr. Hirsch reminded journal readers that proper documentation can justify the added expense of a dual-chamber pacemaker -- when indicated -- helping ensure that physicians provide proper treatment for their patients, protect physician/hospital revenue, keep providers educated, and maintain compliance.
Chosen from numerous submissions, Dr. Hirsch's letter highlighted key information related to justifying patient need for procedures that are constantly changing. Thus, there is a need to keep the physicians who read JAMA and the rest of the medical community well-versed in regulatory changes for documentation.
In the letter, Dr. Hirsch alerts cardiologists that their cardiac patients must meet specific criteria to qualify for reimbursement for a dual-chamber pacemaker implantation. The Centers for Medicare & Medicaid Services (CMS) has published a national coverage determination (NCD20.8), specifying when CMS will pay for a pacemaker implantation with criteria for both single-chamber and dual-chamber pacemakers. He distinguished the coverage criteria between single-chamber and dual-chamber pacemakers to help physicians understand why CMS determined coverage.
"While standard practice is to place dual-chamber pacemakers, physicians must be cognizant of the issues of payment in this era of audit and denials by a myriad of organizations, all looking to recoup money from hospitals and physicians," Hirsch said. "Placing dual-chamber pacemakers in circumstances that fall outside the CMS coverage determinations is often clinically indicated. Fortunately, the NCD specifies that payment may be made by CMS if the physician documentation supports that decision."
AccretivePAS® is a comprehensive physician advisory medical necessity solution that helps hospitals and medical facilities confirm their navigation of the regulatory environment so that compliance improves.