Develop a co-management protocol to ensure surgeons and staff follow documentation requirements.

Co-management has become a hot topic due to three large, recent cases against practices in the news. These recent cases had $1.1 million to $17 million dollars in judgments applied due to the appearance of violations of the False Claims Act and Anti-Kickback Statute.¹

Co-management is a care-sharing arrangement between a surgeon performing surgery, the patient, and an external provider providing postoperative care. This is usually elected due to travel hardship for the patient in returning to the surgeon’s office or surgeon unavailability, or the patient may also choose co-management for their own convenience or comfort. Regardless, co-management should be driven by the patient’s needs and desires, according to the American Society of Cataract and Refractive Surgery and the American Academy of Ophthalmology’s joint statement on the clinical appropriateness of co-management.²

Medicare recognizes co-management and provides billing and documentation guidelines that must be followed for compliance. This guidance is found in the Medicare Claims Processing Manual for billing.³ Also, the Medicare Administrative Contractors offer guidance that can be found in their provider portals and the Medicare Coverage Database.⁴

To avoid the assumption of false claims and kickbacks, it is important for practices to follow the rules of co-management and have a co-management protocol in place. This will help to ensure requirements are understood and followed. Clinical staff assist surgeons with appropriate documentation daily in the practice, so they can help to ensure compliant co-management documentation.

How staff can help

A review of best practices for co-management documentation and how clinical staff can help is highlighted in the table below.

Beyond these tips, a helpful co-management detail is to have preoperative confirmation from the external provider that they are available and willing to participate in co-management. This confirmation should be obtained by the surgery coordinator after the patient has signed the co-management consent. The confirmation may be documented by a phone call to the external provider to confirm availability and willingness to participate. Some practices add a signature line to the patient’s consent for the co-managing provider to sign as an confirmation.

Co-management risks

Practices can get into trouble by applying co-management too liberally, such as to every patient, every patient from referring providers, or as a primary practice growth mechanism. It can then appear as a routine or lucrative arrangement to acquire referrals. Surgeons are expected to follow their surgical patients unless there is a compelling reason they cannot.

Summary

Co-management offers the ability to provide continuity of care when difficulties or inconveniences exist that could hamper follow-up care, if documentation supports a compliant and individual process for each patient. The co-management arrangement was designed to address these situations to support excellent outcomes. Clinical staff have a valuable role to play in co-management compliance. OP

REFERENCES:

1. Office of Inspector General. Fraud & Abuse Laws. https://oig.hhs.gov/compliance/physician-education/fraud-abuse-laws/ . Accessed July 21, 2023.
2. Comprehensive Guidelines for the Co-Management of Ophthalmic Postoperative Care. American Academy of Ophthalmology. https://www.aao.org/education/ethics-detail/guidelines-comanagement-postoperative-care . Accessed July 21, 2023.
3. Centers for Medicare & Medicaid Services. Medicare Claims Processing Manual: Chapter 12 - Physicians/Nonphysician Practitioners. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf . Accessed July 21, 2023.
4. Centers for Medicare & Medicaid Services. Medicare Coverage Database. https://www.cms.gov/medicare-coverage-database/search.aspx . Accessed July 21, 2023.