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Mastering Proper Implant Charges & Billing Processes

03 Mar 2017, Posted by Jocelyn Gaddie in Billing, Healthcare, Revenue Management

Managing the coding, billing and payments related to implants involves a lot of individuals—everyone carries their own piece of the puzzle and it’s important to have every piece in the right place. So how do you get the pieces together correctly the first time? First and foremost, communication. After that, it’s all about keen attention to detail.

Avoid Costly Roadblocks with Communication

Every aspect of revenue cycle management demands teamwork, and communication is critically important. But this can be a simple endeavor, too. Whether coordinating with an internal team or third party billing group, all it takes is a little process for communication to be as easy as a passing “Heads up!” or “FYI!”

When managing the coding and billing of implants, the right hand and left must work together seamlessly and everyone who holds a piece of the puzzle should keep the rest in the loop.

  • Clinical staff must communicate with physicians to ensure operative reports are completed quickly and accurately.
  • If questions of cost or verification arise regarding implants or tools associated with an implant, the materials manager should coordinate with the billing group.
  • All invoices associated with an implant, including individual tools and accessories, must be made available during the RCM process.

Boost Revenue with Attention to Detail

Regard the following list as basic rules of engagement for capturing and managing implant charges. Playing by these rules will help your center avoid having to cover implant-associated costs that cannot be billed back to a patient.

  • Determine whether separate authorization is needed for high-dollar implants. If authorization is required but not secured, reimbursement may be denied.
  • Enter as much detail as possible into implant documentation, including the operative report and implant log. This avoids later questions and confusion.
  • Organize implant invoices to allow tracking of stock and non-stock items. Invoices can be forwarded to a billing group or entered into a software tracker.
  • Match all invoices to the implant log to provide a kind of checks and balance system.
  • Review the manufacturer’s information on coding, billing and reimbursement for larger or unusual implants and share that information with clinical and billing staff.
  • After charges are billed, review and appeal any denials or under payments based on contracts.

Remember: if you don’t play by the rules, you’re more likely to encounter denials, and any time you try to get something from a payer after the initial claims cycle, your chances are always diminished. Options are much more limited once you’re denied.

Make the Most of Your Team & Your Tools

They say the devil is in the details. And nowhere is that more apparent than when dealing with implant charges and billing. If your center is struggling to keep up with the intricacies of implant charges, give in2itive Business Solutions a call—we can help refine your processes, provide training on billing software, and guide your team in more effectively managing every last implant detail.

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