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MedBen ICD Placement Reviews Save Clients Millions

10/02/15

  10:23:00 pm, by MedBen5   , 337 words,  
Categories: News, Health Plan Management, Hospitals, Heart

MedBen ICD Placement Reviews Save Clients Millions

ICD

The federal government is currently challenging hospitals regarding excessive and inappropriate use of implantable cardiac devices (ICDs)... the same excessive and inappropriate use MedBen has been catching for years.

According to Modern Healthcare, hundreds of hospitals have settled with the Department of Justice as part of a multiyear, nationwide investigation into the suspected overuse of implantable cardioverter defibrillators, or ICDs. Settlement figures have not been made public, but individual SEC filings suggest the cumulative amount could total in the billions of dollars.

Under Medicare rules, ICDs cannot be implanted within 40 days of a heart attack or 90 days of bypass surgery or angioplasty. But upwards of 40% are implanted contrary to clinical practice guidelines, as they may not be medically necessary.

MedBen follows similar standards as Medicare, which reflect industry standards for appropriate placement of the cardiac devices. Additionally, MedBen has been performing clinical reviews on ICDs for its clients since 2007 – three years before the Office of the Inspector General started its review. During that time, we discovered and denied 63 inappropriate ICD device placements, saving almost $2.5 million for clients.

“This is a standard part of our clinical review process,” said Kurt Harden, President and COO of MedBen. “Coding software and standard claim payment reviews don’t catch these unnecessary charges. Only a detailed clinical review by cardiologists can root out unnecessary ICD placements.”

At $40,000 or more per unit, ICDs are among the most expensive devices to treat abnormal heart rate – and the devices need to be replaced every 5 years for the life of the patient. But in certain cases, a less expensive pacemaker, or even medication, may be sufficient to treat the condition.

Harden added that MedBen's comprehensive review process doesn't stop with ICD devices. "We employ a team of over 125 expert physician reviewers and a one-of-a-kind system that routes and reviews the claims quickly for clients. The savings are significant and our physicians step in to help the client and the member," he said.

Clients with questions regarding MedBen’s cardiovascular review procedures are welcome to contact Kurt Harden at 888-633-2364.

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