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Topic: Negotiate device payment into contracts

Ambulatory Surgery Reimbursement Update, December 2, 2008

Don’t forget to address payment for devices in your payer contracts.

“The best thing to do is to look at your cases as a whole, what procedures you usually perform,” says Dawn Gray, CPC, CCP, director of operations at Serbin Surgery Center Billing, LLC, in Fort Myers, FL.

Consider negotiating with payers to carve out the nerve stimulators or infusion pumps, or try to negotiate a case carve-out.

“Make sure the allowable for these devices is more than what your actual cost is,” Gray says.

Many ASCs run into problems having payers reimburse for devices because payers want invoices or better documentation.

If you notice a trend with payers requesting operative notes, invoices, or other additional information before making a reimbursement decision, keep a log and implement a process to include the required information with the initial claim submission, Gray says.

“Implement changes on the front-end process rather than waiting for the denial to come in,” she says.

Editor’s note: This topic is from the December 2008 issue of Ambulatory Surgery Coding and Reimbursement Insider.

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