Short Stay Denials for total knee replacements

Has anyone begun to see Medicare inpatient denials for short stay total knee replacements? I know there was a hiatus on RAC reviews for 2018 and 2019 and RAC has not listed it as an issue. However, we are wondering if any MAC's out there have started reviewing and/or denying these cases. Thanks in advance for your responses.

Comments

  • Hello, Since total knee replacements were removed from the inpatient only list, I don't see traditional Medicare patients in an inpatient status often. These are usually done as outpatient. However, the 2 Midnight Rule is to be used with these cases and a patient with other comorbidities may require at least 2 midnights. With that said, I do see Medicare advantage and some commercial payers precerted for inpatient via their insurance company. Hope this helps.

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