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
