A Dedicated Platform for Hospitals to Ensure Strict & Accurate Compliance
If you are a hospital, ASC or Specialty Medical Facility we can implement
a private, dedciated version of our CMS ICD application software so that you
can distribute the application to your doctors within your facility, access
the entire backend administration reporting system, send real time reports
to compliance officers, and manage your own internal infrastructure to
ensure that all ICD, CRT-P, and CRT-D implantation procedures are 100%
compliant with CMS (Center for Medicare & Medicaid Services) guidelines.
Due to findings in a study published by the National Cardiovascular Data Registry (NCDR) that 22.5% of ICD procedures from 2006 to 2009 did not meet the evidence-based criteria for implantation, it has been determined that the number of incompatible diagnosis and procedure codes are more prevalent than originally anticipated. Furthermore, a significant number of these non-evidence based ICD patients have suffered from in-hospital complications and deaths as a result of their improper initial diagnosis.
In response to this, the Department of Justice (DOJ) has conducted a series of internal investigations of a large number of institutions to review all of the claims for payment for ICD implantations that violated the criteria set forth in the National Coverage Determination. All cases required hospitals to provide the necessary documentation demonstrating that the patient scheduled for an ICD implant met the evidence-based indicators for coverage. Having identified nearly $1.03 billion in inappropriate payments, CMS has been employing Recovery Audit Contractors (RACs) to issue penalties and fines to hospitals in an effort to recover these improper Medicare payments. Under the False Claims Act, the penalties for performing ineligible procedures often result in three times the amount of damages for each claim, steep civil and criminal penalties, and irreparable damage and negative publicity for hospitals and their most-prized physicians.
With some hospitals now facing millions of dollars in fines, it is more critical than ever before that more aggressive measures are taken to avoid exorbitant fees and ensure compliance with Medicare guidelines. By deploying the CMS ICD application to all cardiologists and electrophysiologists within their facilities, hospitals are taking a proactive approach to eliminate non-compliant procedures, avoid DOJ investigations, CMS audits, provide a better quality of care for their patients and help save lives.
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