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UVMFLOWNET  January 2014

UVMFLOWNET January 2014

Subject:

Re: Non saphenous vein reflux

From:

Derek Butler <[log in to unmask]>

Reply-To:

UVM Flownet <[log in to unmask]>

Date:

Fri, 24 Jan 2014 15:38:25 +0000

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (103 lines)

Your 'soapbox' is positively recieved-ah the good old days when the pt came first (synical)- i remember those days-once again does anyone here think the medical community helped  create the stratification we now see though claims because certain medical personell got a bit greedy combined with the sudden demand the endovenous technology made possible got the insurers surpised at such demand-pandoras box has been opened and will never close it is felt. Collectively speaking, we know more now than ever and combined with ever more succint technology increasing our diagnostic confidence (from ct to u/s ect) has caught an insurance system that cant keep up thus creating more stringent guidelines for approval-in the endoven segment- i know i was shocked wen i found out how much rfa,s reimbursed- some contracted places ive witnessed do 7 a day 5x a week-woah. Once that cycle begins for some it is hard to break.

Sorry for grammer-soapboxing myself from android country.
________________________________________
From: UVM Flownet [[log in to unmask]] on behalf of Bill Schroedter [[log in to unmask]]
Sent: Friday, January 24, 2014 10:23 AM
To: [log in to unmask]
Subject: Re: Non saphenous vein reflux

I just have to jump up on my soapbox here. (Unless you mistake – this is the “other” Bill)

We of course deal with the insurance issues constantly and over the years have altered our reports in order to streamline coverage determinations (especially with private insurers.) In fact, I admit, we have dumbed down our reports. In an effort to obtain coverage for our patients (not completely wrong), we are basically allowing insurers to dictate and even set reporting standards as opposed having the medical community set these standards.  This is completely wrong and I believe will eventually prove disastrous to medicine. We need to create the environment in which the insurers are forced to adapt to medical reporting standards.  We should be involving patients more, educating them and requiring the patient to contact their insurers to argue for coverage. Involve the states’ insurance commissioner. Our patients are the customers, not the providers whom insurers have a significant financial incentive to deny coverage. OK - before someone slaps me back into reality, let me admit - I know, I am living in a dream world. Not that one cannot accomplish both, but I still cringe when our reporting verbiage is created to allow coverage as opposed to accurately relaying the findings in the most clinically useful fashion.

Regards, Bill


William B Schroedter, BS, RVT, RPhS, FSVU
Technical Director
Quality Vascular Imaging, Inc
Venice, Florida
(941) 408-8855
www.qualityvascular.com<http://www.qualityvascular.com>
www.compressionsocks.pro<http://www.compressionsocks.pro>



From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Nancy Williams
Sent: Friday, January 24, 2014 9:31 AM
To: [log in to unmask]
Subject: Re: Non saphenous vein reflux

This is so true. I have found myself worrying more over what I provide for the insurers than what I provide to the reading physicians. My docs will tell me sometimes “I don’t want to see that” and I tell them “Never mind you and your needs. Your surgery schedulers need that!”

And yes, I am almost certain that whomever is reviewing is confusing our request for phlebs with EVLA. It is maddening how frequently this is occurring…to the point where I’m pretty sure I’m developing a tick!

From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Dr Jason Roberts
Sent: Friday, January 24, 2014 7:03 AM
To: [log in to unmask]
Subject: Re: Non saphenous vein reflux

Carolyn
Unfortunately we get this all the time as well. Sometime it makes sense to give insurers exactly what they are looking. And sometimess this may be in the best interest of the patient


Dr Jason Roberts
[log in to unmask]<mailto:[log in to unmask]>
954-801-2496
"Try not to become a man of success, but rather a man of value"
-Albert Einstein-


-------- Original message --------
From: Carolyn Semrow
Date:01/24/2014 6:22 AM (GMT-05:00)
To: [log in to unmask]<mailto:[log in to unmask]>
Subject: Re: Non saphenous vein reflux
Of course it may be due to the Letter of Medical Necessity and the treatment plan which generally is a request for several ambulatory phlebectomy session separated by time for system stabilization. It sounds like the claim reviewer is confusing a request for phlebectomy with  EVA. That would be the only reason why they would deny for lack of SFJ reflux.  The in depth explanation of Duplex findings is absolutely necessary we also include the anatomical drawing worksheet showing the status of each vein & location of reflux & obstruction as part  of the Letter of Medical Necessity(LMN) documentation and in some cases photographs of the limb.  Remember claim reviewers are not vascular specialist they might not even have a background in medicine. The most common CVD preauthorization request they receive is for EVA. The LMN may be written in such a manner that in a quick scan of the document it appears to be a request for EVA authorization. It's a new year, codes have changed you might check the ambulatory Phlebectomy code & LCD.

Carolyn M Semrow, RVS

"A master, in the art of living, draws no sharp distinction
between his work and his play, his labor and his leisure,
his mind and his body, his education and his recreation.
He hardly knows which is which. He simply pursues his
vision of excellence through whatever he is doing and leaves
others to determine if he is working or playing. To himself
he always seems to be doing both."
Francois-René Chateaubriand (1768-1848)



The HTML graphics in this message

From: Nancy Williams <[log in to unmask]<mailto:[log in to unmask]>>
To: [log in to unmask]<mailto:[log in to unmask]>
Sent: Thursday, January 23, 2014 8:38 PM
Subject: Re: Non saphenous vein reflux

Thanks, this is great. I appreciate you sharing. I'm sure you are correct about the interpretation. Again, to all who read my previous comment I hope you can appreciate that my frustration is with the insurers who seem to be asking me to provide information and documentation not relevant to the procedure being requested and not to Jason who graciously responded only to be harangued by me for his trouble. My twin sister will tell you in all seriousness, sometimes I am an @$$...it does not go unnoticed.

Nancy Williams

> On Jan 23, 2014, at 9:30 PM, "Registered Vascular Solutions" <[log in to unmask]<mailto:[log in to unmask]>> wrote:
>
> Nancy,
>
> It most likely has to do with the verbiage in the interpretation.  We have no problems (and we get a lot from other vein centers that are not happy).  I agree most of the time the SFJ is preserved as well as the epigastric and very often an incompetent accessory that the previous practice ignored.
>
> You can state that the right great saphenous vein has been closed previously from the saphenous-femoral junction to the proximal calf, however significant reflux is visualized in the native great saphenous vein in the proximal, mid and distal calf as well as tributaries of the great saphenous vein.  There is proximal tibial perforator measuring 4.3 mm. With a reflux time of 1,240 msec. The native great saphenous vein measured 5.6 mm. in the proximal calf and has a reflux time of 4,350 msec. Associated tributaries are visualized at a, b and c.........
>
>

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