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How to Improve Your ASC’s Implant Billing and Collections

How to Improve Your ASC’s Implant Billing and Collections

Managed Care Contracting Guidelines to Improve Reimbursement

Questions to Ask Implant Billing

During a webinar with Becker’s Healthcare, Scott Allen, National Medical’s Senior Vice President of Managed Care Contracting, discussed how ASCs can navigate implant billing by reviewing managed care contract terms.

He explained that when ASCs conduct a case costing analysis, many find that implants can be one of their highest expense items, especially if they are not being billed appropriately. He recommended ASCs review their contracts on an annual basis to determine implant reimbursement eligibility and implant reimbursement thresholds.

“Implant revenue is changing, but by reviewing your managed care contract terms, your facility will be able to determine if you’re overbilling or underbilling and what kind of revenue can be generated,” Scott Allen explained.

 

Watch this 90 second clip from the webinar to learn more:

 

Watch the full hour webinar 5 Overlooked RCM Processes ASCs Must Review for Financial Success.

How do you determine if your ASC is losing any money on implants?

How do you determine if your ASC is losing any money on implants?

 

Scott Allen answers the top four questions to work through with your revenue cycle team regarding implant coding and billing.

How do you determine if your ASC is losing any money on implants?

Scott Allen answers the top four questions to work through with your revenue cycle team regarding implant coding and billing.

 

1. How profitable are your cases with implants?
Having complete and current payer contracts in place is vital in determining if certain implants are profitable for your ASC, if your ASC is currently getting paid appropriately for implants and the best way to bill for implants based on each payer. Once you review the contract language, you’ll notice the payer methodology around implants varies greatly by payer. The contract language will dictate how to mark-up implants and if you can bill using an invoice cost plus structure (bill for the invoice cost of the implant, plus a little extra to cover overhead costs). The contract will explain how much of a percentage an insurer will pay and how much of the cost is left up to the patient to cover. Ultimately, this process will help you determine each patient’s payment responsibility based on payer, what each payer will reimburse, and what your options are with regards to adapting your current implant billing practices.

 

2. Do your contracts have implant billing restrictions?
Most payers have a variety of restrictions and policies surrounding implants. For instance, you should know if there are any restrictions based on a minimum threshold. This limitation allows payers to only reimburse for implants that cost more than a specified amount, such as $500 or more. Some payers require the ASC to include the invoice to receive reimbursement for the implant. You’ll want to check to see if there are any restrictions on the type of implant you can bill and if there are any unique billing requirements (such as a different billing address for submitting implant claims). Also, be aware of any restrictions or rules regarding what a payer considers an experimental procedure. The contract will describe what the experimental procedure is and note that any implant associated with that procedure will not be eligible for reimbursement.

 

3. Do you have a standard mark-up when billing implants?
Having a firm understanding of the payment methodology for each payer will help you develop standard mark-ups for payers that don’t regulate what is paid out versus payers that do. It’s important to know if an insurance carrier pays for the implant separately or if the value is included in the payout for the surgery. Using the wrong revenue code can result in non-payment or underpayment.

 

4. Are your implant payments accurate?
One way to find out is to audit your past payments once you’ve reviewed the terms in your managed care contracts. Understanding the process from coding all the way to patient accounts will help ensure you are billing appropriately and accurately. Maintaining an up-to-date and easily searchable invoice file system will help you access past records more easily for comparison. Tracking your implant reimbursement by cost and collections received will also help you manage your outstanding balances.

 

To learn more about implant billing and payer contract language, methodology, and restrictions, view our webinar 5 Overlooked RCM Processes ASCs Must Review for Financial Success.


This post was published January 23, 2023.

Questions to Ask Implant Billing

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