Pre-service coverage analyses

valerie@valorizeconsulting.comvalerie@valorizeconsulting.com
in COVERAGE
In light of the Targeted, Probe & Educate pre-payment audits as well as Recovery Auditor audits focused on medical necessity and coverage, I am curious how many organizations have implemented some type of pre-service coverage analysis where the patient records from the physician scheduling a procedure are evaluated prior to the procedure to determine if all the coverage requirements of the applicable NCD and/or LCD are met prior to the procedure being performed?

Comments

  • trinkertrinker

    We currently do this in our Wound Center, but we have always done it due to the expense of those services (skin substitues, HBOT, etc).  Now that we are under a TPE for Wound Care, we are finding that although we meet medical necessity a lot of the documentation is scattered through out the medical record.  We are discussing easier ways to get the information to our MAC and exactly who should do this.

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