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 guidelines and are now starting to enforce the need to place the patient in stockings and track them for three to six months.
All of these changes are necessitating changes at the practice level.
First, it is imperative that the guidelines for each payer are reviewed regularly to identify any changes. Second, these changes must be clearly understood by the physician, the medical team, and the authorization coordinator. These are the two ‘easy’ changes.
Third, and becoming increasingly more important, is that the documentation needs to be tailored to a certain extent to meet the payer’s guidelines. For example, Trailblazer and some commercial payers require the patient to be placed in compression hose and monitored by the physician. There must be an initial review of the patient, and order placing them in stockings, a review of any relief or continued symptoms at the 45 day mark, and a similar review at the 90 day mark. All of this needs to be captured in your summary of the patient’s condition as to why you are now recommending an ablation to be performed. Other payers may want you to wait 90 days before performing a phlebectomy. Again, your documentation needs to match the expectations that the patient is re-reviewed and a phlebectomy is ordered based on that follow up visit.
Unfortunately, the old adage that “if you didn’t document it, you didn’t do it” is becoming the rule even before you are authorized to treat the patient.
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