IF You don’t know the rules, you are in for a “very expensive” business lesson.
Viscosupplementation is “part” of the progressive therapy protocols used in the treatment of osteoarthritis and, in many cases, the patient’s last reasonable option before being subjected to surgical corrections such as a total knee replacement. Patients who present to a treatment center however may or may NOT be an “immediate” candidate for supplementation. Even if they are, the carrier’s own requirements may dictate a course of conservative care before we can expect payment. Carriers are now auditing for compliance with their coverage requirements
Many physicians have NOT been properly advised, are still missing income opportunities and find themselves fighting pre-payment denials as well as post payment review paybacks as auditors assert that the providers have inadequate justifications in the documentation for medical necessity. Treating OA of the knee is costly and Carriers are well aware that their expenditures will “significantly increase” not only due to the aging population but also due to the repeated interventions with supplementation procedures. If you are a medical practice that “went it alone” when you added this service, you are probably in for a expensive ordeal as the auditors “cut you off at the knees”.
You get a lot of respect from me for writing these helpful artclies.