Documentation Compliance

Sclerotherapy by Cheryl Nash Sclerotherapy: It is just an injection! So why is so much documentation required for this simple service to be covered by the payers? In fact, Ultrasound Guided Sclerotherapy (also known as USG or Echosclerotherapy) is categorized as a surgical service and needs to be documented according to these standards. Typically USG […]

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Medical Policy Alert

Humana Moves Towards AEtna’s Policy by Cheryl Nash Some of you may have noticed the new changes to the language in Humana’s coverage policy. Along the lines of last year’s changes to Aetna’s guidelines , Humana has also added a notation in their guidelines stating: Initially, one treatment session of RFA, TIPP or, EVLT™, per […]

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E-Prescribing Requirements

Out Clause for Phlebology by AJ Riviezzo One of the new(er) concerns we have been fielding of late is the Medicare decision on E-prescribing. Medicare is turning it from a small bonus to a penalty if you are not in compliance. While the 1% reduction for next year isn’t large, it will increase each subsequent […]

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Local Coverage Determinations

Matching Tit for Tat by AJ Riviezzo The requirements by the various payers continue to evolve and shift. Some, like United Healthcare, have become slightly more user friendly as they finally recognized that wearing stockings for three months does absolutely nothing for a patients venous disease. Others, like the Medicare intermediary Trailblazer, have changed their […]

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Audit Alert

More Fun by a Payer by Cheryl Nash Humana has started issuing letters requesting medical records for an audit of their Medicare Advantage Plan members. We have received information of from two providers in phlebology practices that have received the same request – in different states. This appears to be a random audit to compare […]

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Conservative Treatment Changes

Documenting Stockingsby Cheryl Nash and AJ RiviezzoIn the past the patient report regarding the wearing of compression stockings was sufficient. Unfortunately, a passing ‘nod’ is no longer sufficient by a growing list of payers. With the Phlebology requirements becoming more and more payer specific, a trend has been emerging that may change the way you […]

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Blues Audit to Recoup $72,000

A Cautionary Taleby AJ RiviezzoA provider was audited by the Blues in their home state. They reviewed twenty charts. Not very many overall. Based on these twenty charts the determined that the level of coding for new patient and current patient office visits was not supported by the documentation. The Blues determined that instead of […]

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CIGNA Changes

More Fun by a Payerby AJ RiviezzoOur friends at CIGNA are now placing a limitation of services on their policies (those that even have ablations allowed in the first place). They will only authorize two vein treatments per year. There is an exception as you may call to re-authorize if there is a compelling need. […]

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Insurance Plan Riders

Sneaky Exclusionsby AJ Riviezzo and Cheryl NashWe have seen a growing use of ‘riders’ for self funded plans. To help keep premium costs low, these self funded plans have carved a number of niches or riders out of the normal plan. We have seen a growing number of these riders being focused on varicose vein […]

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AETNA Clinical Bulletin

Some Clarification by the Planby Cheryl NashThere has been an interesting new paragraph added to Aetna’s Clinical Policy Bulletin number 0050, treatment of varicose veins. The addition states that one treatment session of endovenous catheter ablation per leg is generally considered medically necessary, as endovenous ablation of the entire incompetent saphenous vein usually can be […]

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