AAHKS Input on Audits, Authorizations and Approvals of Inpatient TKA

Despite AAHKS’s calls for clarity from the Centers for Medicare and Medicaid Services (CMS), there has been continued disorder regarding the removal of TKA from the Inpatient Only (IPO) List. Although CMS committed to suspending audits by Medicare Recovery Audit Contractors (RACs) for 2 years, members have reported other CMS audits, such as those by quality improvement organization (QIO) contractors. QIOs assume the task of reviewing claims over appropriate admission status for short stays.

Your feedback is vital to the success of AAHKS and our advocacy efforts. Please take a few minutes to answer the short survey below. We need your help to work with Congress and CMS to prevent our TKA patients from experiencing adverse consequences due to the regulatory change.

Question Title

* 1. What is your practice type?

Private Practice

Hospital Employed

Academic Practice

Hybrid Model

Question Title

* 2. How many TKAs do you annually perform?

Less than 50

50-100

100-200

Greater than 200

Question Title

* 3. How do you schedule your TKA patients who are Medicare beneficiaries?

All are scheduled as an inpatient procedure and the hospital can change the status to outpatient

All are scheduled as an outpatient procedure and the hospital can change to an inpatient admission if it is necessary

I determine inpatient or outpatient status based upon what I feel is medically necessary

The hospital determines whether an inpatient or outpatient designation is most appropriate

I do not know

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* 4. What documentation do you provide for inpatient justification for TKA?

Preoperative office visit

Day of Surgery H&P

Operative Note

Inpatient Progress Notes

I do not document reasons for inpatient TKA

Question Title

* 5. What documentation do you provide to justify an outpatient, or rapid recovery TKA procedure?

Preoperative office visit

Day of Surgery H&P

Operative Note

Inpatient Progress Notes

I do not provide documentation for outpatient or rapid recovery TKA

I do not perform outpatient or rapid recovery TKA

Question Title

* 6. Have you ever had to obtain preauthorization for inpatient status for TKA or had to appeal if an inpatient status was denied preoperatively?

Yes, several times per month

Yes, monthly

Yes, but fewer than once per month

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* 7. Have you ever had a TKA patient contact your office with questions regarding their inpatient or outpatient status?

Yes, regarding a copayment for the outpatient procedure

Yes, regarding concerns about their hospital length of stay

Yes, with other concerns

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* 8. Have you ever been involved with a CMS Quality Improvement Organization (QIO) contractor audit for an inpatient TKA stay?

Yes

If yes, please comment

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* 9. If yes, was a patient inappropriately denied an inpatient admission based upon AAHKS’s proposed exceptions, other publically available resources, or your clinical judgement?

Yes

If yes, please comment