Medicare and other third-party payers have started predicating reimbursement on adherence to standards of care. Post hoc chart reviews have resulted in substantial take-backs for failure to adhere to those values in cardiology, pulmonology and expanding to other areas. Outpatient medicine is also being subjected to such scrutiny.
Explore this issueMay 2016
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The question of standards and who sets them can be debated. After all, the product of a committee may not fully reflect the intent/perspectives of its members. The result is sometimes a range for such matters as monitoring medication safety. Such is the case with respect to disease-modifying anti-rheumatic drug (DMARD) safety surveillance.
The published safety surveillance range is one to three months, the latter representing the longest interval that the American College of Rheumatology and the 3E (Evidence, Expertise, Exchange) Initiative committee members recognized as safe—although most favored monitoring at the shorter interval.1,2 At some point, the insurance industry will demand adherence to that standard for DMARDs, as the legal system already has in malpractice cases.3| | | Next → | Single Page