Conservative Management- that’s the buzz term you need to know in insurance coverage policies. But what does this mean to your practice? Probably not what you would like to hear.
Management means medically supervised conservative treatment, and while this includes prescription strength compression stockings that have been properly measured and ordered, it also means exercises, leg elevation, use of NSAIDS, warm soaks, weight loss if indicated, and all of these need to be charted and monitored by a physician.
But your patient says they have been doing this for years! They are frustrated and want to know why they have to go through these hoops and jumps. You are frustrated too and want to know why this will not suffice.
The reason is that patient self-treatment is not recognized by the payer as medical treatment. A comparable example is steroid injections with physical therapy. Say you have suffered from back pain for years. You found information online about exercises you can try to alleviate the issue and have been diligent in their application. You now have been formally diagnosed and recommended for interventional treatment by a specialist, but your insurance requires you to try non-surgical methods first. You protest as you have been doing these exercises for the last 3 years, so why should you have try PT?
The reasoning is, maybe you haven’t been consistent, maybe you have missed a few steps, maybe you were doing it wrong or not using the correct equipment. Whatever the reason, your self-treatment does not qualify as medically managed care, and the payers will not take your word for it. Ultimately, the patient is not a doctor, and therefore does not meet the requirements set forth by the insurance.
In the end, if the patient would like their insurance to cover their services, they have to go through the hoops set in front of them. As do you, the provider, if you would like to avoid the risk of an audit recouping all monies accepted from the treatment of your patients due to non-compliance. The primary denial we see from Medicare audits is the lack of a well-documented conservative therapy program.
No comments yet.