There are many factors that may cause the lack of implant reimbursement, with the most common including implant usage not properly (or at all) documented by physicians and the need for proper documentation for ASCs to receive payment (i.e., actual invoice of the implant).
Listed below are four best practices that GENASCIS recommends for ASCs to receive full reimbursement for billable implants.
1. Create an implant billing matrix.
Listing all procedures that should always have an implant billed and have a separate listing of procedures that could have an implant billed.
Editor’s note: To view the 17 orthopedic procedure CPT codes with billable implants, click here.
2. Check the matrix at the point of coding..
3. Ensure proper documentation to bill and collect.
4. Build rules into billing and/or claims systems to flag cases for manual review.
Learn more about GENASCIS.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.