December 2, 2020
By Mark Spivey
Special Bulletin: PFS Final Rule Issued, TKA Being Added to PEPPER, NCD Changes for Artificial Hearts
Federal officials recently announced a flurry of regulatory changes. Recent federal regulatory changes governing the Physician Fee Schedule (PFS), reporting on total knee arthroplasty (TKA), and coverage of the use of artificial hearts have all made headlines during recent weeks – matters that may have flown under the radar considering…
May 16, 2019
By Ronald Hirsch, MD
CMS Hints at Outpatient Total Knee Bundle
Adding TKA to the BPCI appears to be more involved than anticipated. As reported by the American Hospital Association and other organizations, starting in 2020, the Centers for Medicare & Medicaid Services (CMS) will be adding outpatient total knee arthroplasty (TKA) to the list of episodes in the Bundled Payment…
November 15, 2018
By Juliet B. Ugarte Hopkins, MD, CHCQM-PHYADV
The Total Knee Arthroplasty Controversy Gets (Even More) Confusing
“Outpatient” does not equate “same-day.” By this time last year, the Centers for Medicare & Medicaid Services (CMS) had notified providers that they were removing total knee arthroplasty (TKA) from the Medicare inpatient-only list. While the cries of disbelief and howls of frustration eventually died down after a few months,…
July 16, 2018
By Chuck Buck
Total Knee Replacement Denied? CMS Wants to Know
Unique opportunity. Hospitals urged to use great discretion. The Centers for Medicare & Medicaid Services (CMS) wants to know if your total knee replacement (TKR) claims have been denied. Ronald Hirsch, MD, made the announcement today during the weekly broadcast of Monitor Mondays when he reported that he has received…
By Ronald Hirsch, MD
If there is a pattern of inappropriate denials, report it to your CMS regional office Are all of you refreshing your browser every 15 minutes waiting for the Centers for Medicare & Medicaid Services (CMS) to release the Outpatient Prospective Payment System (OPPS) proposed rule? I didn’t think so. But…
May 31, 2018
By Ronald Hirsch, MD
CMS Regulations Continue to Confuse and Confound
The author responds to comments from readers of his recent RACmonitor article. The May 17, 2018 RACmonitor news article Two-midnight Rule Remains Confusing; Total Knee Replacements Frustrating to Many resulted in several comments before I had even finished my first cup of coffee. Chuck Buck, RACmonitor editor and host of…
By Lori O’Hara, MA, CCC-SLP
The author provides a long-term care provider’s perspective on TKA patients. While reading Dr. Juliet Ugarte Hopkin’s recent article on criteria for skilled post-acute care for total knee arthroplasty (TKA) patients, my brain went into claim defense mode. As a post-acute rehabilitation director I was tasked with ensuring our patients…
By Ronald Hirsch, MD
Recoupment and one-day inpatient admission for total knee replacement. EDITOR’S NOTE: The following is a summary of a broadcast segment on Monitor Monday, May 7 by the author. While we are still trying to make sense of what the Centers for Medicare & Medicaid Services (CMS) meant with its proposal…
April 26, 2018
By Juliet B. Ugarte Hopkins, MD, CHCQM-PHYADV
Reconsidering the 2018 TKA Final Rule: Part I
I am changing my interpretation of the final rule with help from the trenches. Often referred to as the “carpenters” of medicine, orthopedic surgeons are not well-known for deep contemplation of Centers for Medicare & Medicaid Services (CMS) rules. But I’ll be damned if I haven’t had to wrestle with…
By Ronald Hirsch, MD
Orthopedic surgeons are upset with various interpretations of regulations on total knee replacement coming from CMS. The saga of determining the proper status for Medicare total knee replacement (TKR) patients continues. As many people know, you do not want to upset a surgeon. And it appears that the Centers for…
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Adam J. KleinAllen Jost, PhDAlvin Gore, MD, CHCQM and Cathi Charlberg, LVN, CHCQMAmanda Gilliland, RN, BSNAmber Soucy, MSN, RNAndrew B. Wachler, Esq.Andrew B. Wachler, Esq. and Emma E. TrivaxAndrew H. Hughes, MD and Charles Locke, MD, CHCQM-PHYADVAndrew Wachler, Esq. and Kaitlin Nucci, Esq.Andrew Wachler, Esq., and Sarah Hillegonds, Esq.Angela Phillips, PTAspen AlbrightBarbara Vandegrift, RN, BSN, MABecky Rodrian, CPC, CEMC, CBCS, MBSBenjamin Kartchner MD, CHCQM-PhyAdvBrian T. LandryChristina Panos, RHIA, CTRChristopher Halleman, DOChristopher J. Laney, Esq.Chuck BuckClark AnthonyColleen Morley, DNP, RN, CCM, CMAC, CMCN, ACM-RNDaniel Zirkman, MDDavid A. McKenzie, CAEDavid Jury MD, MSDavid M. Glaser, Esq.Delilah Davis, RN, BSN, CCADenise Coleman, LPNDenise Nash, MD, CCS, CIMDheeraj Mahajan, MD, FACPDuane Abbey, PhD, CFPEdward Hu, MD and Charles Locke, MDEdward Roche, PhD, JDElizabeth C. Dunbar, MD, MBA, FACEP, CHCQM-PHYADVEllen Fink-Samnick MSW, ACSW, LCSW, CCM, CRPEllen Parucka Walker LCSW ACSWErica E. Remer, MD, CCDSErin Diesel Roumayah, Esq.Frank D. Cohen, MPA, MBBGlenn Krauss, RHIA, BBA, CCS, CCS-P, CPUR, CCDS, C-CDI, PCS, FCS, C-CDAMGloryanne Bryant, RHIA, RHIT, CCS, CCDSGreg FordHolly Louie, RN, BSN, CHBMEJ. Paul Spencer, CPC, COCJanelle Ali-Dinar, PhDJeffrey D. Lehrman DPM, FASPS, MAPWCAJessica Forster, Esq.John Foggle, MDJohn K. Hall, MD, JD, MBA, FCLM, FRCPCJulia K. Brodt, PhDJuliet B. Ugarte Hopkins, MD, CHCQM-PHYADVKaitlin Nucci Esq.Kathleen K. Borchard, BSN, RN-ACMKathy Seward, MD, CHCQM-PHYADVKim T. Charland, BA, RHIT, CCSKnicole C. Emanuel Esq.Kristi Pollard, RHIT, CCS, CPC, CIRCC, AHIMA-approved ICD-10-CM/PCS trainerLaurie M. Johnson, MS, RHIA, FAHIMA AHIMA Approved ICD-10-CM/PCS TrainerLeslie Marsh, RN, BS, MSN, MBALori O’Hara, MA, CCC-SLPMadison AllenMaggie Elehwany, JDMark SpiveyMarvin D Mitchell, RN, BSN, MBAMary Beth Pace, RN, BSN, MBA, ACM, CMACMary Inman, Esq. and Anne Hayes Hartman, Esq.Mary Inman, Esq. and Max Voldman, Esq.Matt Lambert, MDMatthew AlbrightMaureen Testoni Esq,Max Voldman, Esq.Melinda Battaile, MD, FHM, MMCI, CHCQM-PHYADV, CCDSMichael A. Salvatore, MD, FACPMichael KennedyMichael Rosen, Esq.Nancy J. Beckley, MB, MBA, CHCNena Scott, MSEd, RHIA, CCS, CCS-P, CCDSPhillip Angello, MDRalph Wuebker, MD, MBARichard “Dick” Beckley, YNS, USN, 1966-1970Robin Sewell, CDIP, CCS, CPC, CICRonald Hirsch, MDSarah Hillegonds, Esq.Sean M. Weiss, CEMA, CMCO, CPMA, CPC-P, CMPE, CMPM, CPC-PSean Weiss, CHC, CEMA, CMCO, CPMA, CPC-P, CMPE, CPC and David Glaser, Esq.Shannon Deconda, CPC, CPC-I, CEMC, CMSCS, CPMA®Stanley Nachimson, MSStefani Daniels, MSN, RN, CMAC, ACM and Tiffany Ferguson, LMSW, ACMStefani Daniels, MSNA, ACM, CMAC
