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Orthopaedic Surgeons in Oklahoma need to be aware of the additional oversight that the Medicare Administrative Contractor (MAC) TrailBlazer will be placing on the documentation provided in the hospital record for Total Joint procedures.
Following a similar program established in other jurisdictions across the country, last fall TrailBlazer announced their initiative to perform addition "cross-claim medical reviews" on Part A and Part B documentation for total hip and total knee procedures.
Links to their announcements can be found below.
This initiative is similar to efforts underway in other jurisdictions that have received high CERT error rates for in-patient procedures due to insufficient documentation of medical necessity in the hospital charts. TrailBlazer acknowledges in the article that they believe the documentation of necessity probably exists in the physician chart, but they are concerned that this documentation is not also included in the hospital record.
Surgeons across the nation are being encouraged to pay special attention to the documentation they provide for in-patient procedures to ensure they are providing sufficient detail to avoid the necessity of the procedure being challenged during these Part A reviews. TrailBlazer has provided some examples of documentation that they feel may be adequate to document medical necessity. A link to those examples is below.
This is the announcement from TrailBlazer: http://www.trailblazerhealth.com/Tools/Notices.aspx?DomainID=1&ID=14572
This is additional detail on their announcement: http://www.trailblazerhealth.com/Tools/Notices.aspx?DomainID=1&ID=14561
This is the guidance from TrailBlazer for how to better document medical necessity for total joint replacements. http://www.trailblazerhealth.com/Tools/Notices.aspx?DomainID=1&ID=14362
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