The Centers for Medicare & Medicaid Services (CMS) has had multiple auditing entities, including the Recovery Auditors, Comprehensive Error Rate Testing (CERT) Contractors, and Medicare Administrative Contractors (MACs) review claims for total major joint replacements such as hips and knees. Their findings have demonstrated very high paid claim error rates among both hospital and professional claims associated with major joint replacement surgery.
The Centers for Medicare and Medicaid Services (CMS) has published a booklet regarding hip and knee joint replacements that provides information on the following:
- How to document medical necessity
- Complete and accurate medical records
- Key points for billing codes
- Aids to correct billing
To access the booklet, click HERE.