SOLVED2381

Felecia is a 68-year-old Medicare patient with severe spinal osteoarthritis. In an effort to alleviate her lower back pain, artificial lumbar disc replacement surgery was performed at her local hospital. Medicare does not cover artificial disc replacement surgery in patients age 61 or over. What is the likely result if the hospital were to send the MAC a bill for Felecia’s disc replacement surgery? The MAC will deny the claim because the patient is 68 years old. The MAC will automatically pay the claim because Medicare does not require prior authorization for surgery. The MAC will suspend the claim, request Felecia’s records, review the claim, and then pay the claim because it was medically necessary. The MAC will reject the claim and send it back to the hospital to be corrected and resubmitted.
SCIENCE
HEALTH SCIENCE
NURSING

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