Outpatient Surgery Magazine - Subscribers

COVID-19 Crisis - Outpatient Surgery Magazine - April 2020

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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payments remains underused, partly because the process to get reim- bursed for the separate payments can be difficult to understand and implement. The perceived difficulty in getting paid separately from the cataract payment bundle has caused some surgeons and facilities to limit their use of these drugs. Fortunately, there are some relatively simple ways to make sure your facility is properly reimbursed and taking advantage of the pot of use-it-or-lose it money that CMS sets aside for these medications each year. • Contact billing teams. The makers of all three drugs provide online access to interactive tools that can help you navigate the reim- bursement process. They can also connect you with case managers that will work with your facility to incorporate pass-through payments into your revenue stream. The manufacturers' reimbursement teams can also provide information about patient assistance programs for those who qualify. • Begin with Medicare B. Products with pass-through statuses have reliable reimbursement processes for these patients. Check whether your non-Medicare Part B payer contracts that are spe- cific to your facility allow for separate payments of pass-through drugs. Consider renegotiating contracts that do not permit pass- through payments. • Fine-tune the process. Maintain communication with your sur- geons' practices to make sure the pass-through drug will be available for the appropriate patients. To help ensure patients will have coverage for a pass-through product, some physicians' practices flag charts with a sticker and add drop-down alerts in EMRs to remind providers to keep the payment process on track. Make sure all claims submissions are timely and accurate. If any claim is denied, pursue the appeals process and include a letter of med- 8 6 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • A P R I L 2 0 2 0

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