More Fun by a Payer
by AJ Riviezzo
Our 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.
For example, Ms. Smith needs both GSV’s and SSV’s treated. You decide to authorize and treat the two GSV’s. Now, at the one month follow-up visit, Ms. Smith’s SSV’s show no improvement and she still complains of pain, swelling and night-cramps. You may be able to get this treatment authorized but it will require another request and likely further documentation. Dependent on how the guidelines are being interpreted, you may have to hold a peer-to-peer conversation with the CIGNA Medical Director.
CIGNA has also recently announced in one of their online newsletters that the focus for audits this year is… Evaluation and Management coding. In keeping with our article above, please ensure your documentation is bullet proof. Everyone appears to have focused on this area this year. Not because of the high dollars but because of the ease in which they can find fault. Even if you are using an EMR, there can still be some nuances that are missed. Please have your work proofed.
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