May 16, 2019
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
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
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…
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
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…
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…
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
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…
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…
March 1, 2018
An Update on Total Knee Replacement (Sort Of)
CMS open door forum reveals clarity of policy still lacking for total knee replacements. We are two months into 2018, and the level of clarity regarding how to determine the status of Medicare patients undergoing elective total knee replacements is no better than it was on the day in November…
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Allen Jost, PhDAlvin Gore, MD, CHCQM and Cathi Charlberg, LVN, CHCQMAmanda Gilliland, RN, BSNAndrew B. Wachler, Esq.Andrew H. Hughes, MD and Charles Locke, MD, CHCQM-PHYADVAndrew Wachler and Kaitlin NucciAndrew Wachler, Esq., and Sarah Hillegonds, Esq.Angela Phillips, PTBarbara Vandegrift, RN, BSN, MABecky Rodrian, CPC, CEMC, CBCS, MBSBrian T. LandryChristina Panos, RHIA, CTRChristopher Halleman, DOChristopher J. Laney, Esq.Chuck BuckDaniel Zirkman, MDDavid M. Glaser, Esq.Denise Nash, MD, CCS, CIMDheeraj Mahajan, MD, FACPDuane Abbey, PhD, CFPEdward Roche, PhD, JDElizabeth C. Dunbar, MD, MBA, FACEP, CHCQM-PHYADVEllen Fink-Samnick MSW, ACSW, LCSW, CCM, CRPErica E. Remer, MD, FACEP, 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, CHBMEJ. Paul Spencer, CPC, COCJanelle Ali-Dinar, PhDJeffrey D. Lehrman DPM, FASPS, MAPWCAJessica Forster, Esq.John K. Hall, MD, JD, MBA, FCLM, FRCPCJuliet B. Ugarte Hopkins, MD, CHCQM-PHYADVKathleen 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, FAHIMALori O’Hara, MA, CCC-SLPMark SpiveyMarvin D Mitchell, RN, BSN, MBAMary Beth Pace, RN, BSN, MBA, ACM, CMACMary Inman, Esq. and Max Voldman, Esq.Matthew AlbrightMax Voldman, Esq.Melinda Battaile, MD, FHM, MMCI, CHCQM-PHYADV, CCDSMichael A. Salvatore, MD, FACPMichael Rosen, Esq.
