AAHKS Input on Audits, Authorizations and Approvals of Inpatient TKA

Despite AAHKS’s calls for clarity from the Centers for Medicare and Medicaid Services (CMS), there has been continued disorder regarding the removal of TKA from the Inpatient Only (IPO) List. Although CMS committed to suspending audits by Medicare Recovery Audit Contractors (RACs) for 2 years, members have reported other CMS audits, such as those by quality improvement organization (QIO) contractors. QIOs assume the task of reviewing claims over appropriate admission status for short stays.

Your feedback is vital to the success of AAHKS and our advocacy efforts. Please take a few minutes to answer the short survey below. We need your help to work with Congress and CMS to prevent our TKA patients from experiencing adverse consequences due to the regulatory change.


1.What is your practice type?
2.How many TKAs do you annually perform?
3.How do you schedule your TKA patients who are Medicare beneficiaries?
4.What documentation do you provide for inpatient justification for TKA?
5.What documentation do you provide to justify an outpatient, or rapid recovery TKA procedure?
6.Have you ever had to obtain preauthorization for inpatient status for TKA or had to appeal if an inpatient status was denied preoperatively?
7.Have you ever had a TKA patient contact your office with questions regarding their inpatient or outpatient status?
8.Have you ever been involved with a CMS Quality Improvement Organization (QIO) contractor audit for an inpatient TKA stay?
9.If yes, was a patient inappropriately denied an inpatient admission based upon AAHKS’s proposed exceptions, other publically available resources, or your clinical judgement?
Current Progress,
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