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Wiki Ventral Hernia Repair Recoups

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mirandamaz

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Has anyone else been getting hit with Ventral Hernia repair recoups from UHC and Humana for 2023? Their reasoning is that we didn't provide "preoperative" hernia measurements (I think this is taking way too much liberty with the guidelines). Some reps have even said that it should be documented in the note when the decision for surgery was made. They are even recouping when we only billed for less than 3cm (the smallest size). Our providers are arguing that there is not really a way to accurately assess pre-operatively - especially in obese patients. Also in the case of a "swiss cheese" defect, or multiple defects - they don't always know they exist until they get into the OR.

I would love to know if this is happening elsewhere and what approaches you may be having success with...
 
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