Many ASCs do not properly bill implants, according to a study conducted by GENASCIS, a provider of billing, revenue cycle management services and supporting technologies for surgery centers. GENASCIS analyzed 17 primary orthopedic procedures that should always include the use of implants to determine if facilities are successfully billing implants and, if not, the impact of this behavior. Based on an analysis of 332 surgery centers which performed 45,238 orthopedic cases with implants, 29.6 percent of cases did not have implants billed. Only 10.2 percent of these cases contain billed implants and have payments received with full allowable reimbursement.
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.