Avoid Implant-purchasing Headaches

By: Outpatient Surgery Editors

Published: 9/9/2008

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Four tips for working with third-party billing companies


The pricey surgical implants the bane of your existence? Join the club. Skyrocketing implant costs and unpredictable reimbursements make controlling implant expenses essential to a facility's profitability. While coming out on the winning end of the implant reimbursement game remains a mystery for most, Kecia Rardin, RN, administrator and director of nursing at Northwest ASC in Portland, Ore., makes a compelling case for working with third-party implant billing companies. The firms purchase implants from manufacturers and bill commercial payors for the cost. Yes, you collect only a facility fee and forfeit any implant revenues to the third-party biller, but you're off the hook for recouping the implant's cost. What you lose in profit potential, you gain in payment certainty. It's a foolproof plan, says Ms. Rardin, if you follow her advice:

 

  • Forget Medicare patients: Third-party implant billing services won't bill Medicare. Simple enough.

     

  • Keep it simple: Ask the implant manufacturer if it has a working relationship with a third-party billing company. Working with parties who are familiar with each other is best.

     

  • Work together: Organize a meeting with representatives from the billing service, implant manufacturer, surgery center and surgeon's practice. Establish your expectations at the start and align them with the expectations of everyone involved.

     

  • Rely on physician schedulers: By the time patients walk through your doors on the day of surgery, the necessary paperwork should already be complete.

    Here???s more on the ways third-party implant purchasing can take the guesswork out of getting paid for expensive implants. See "Managers Get Tough On Implants" in the July 2007 issue of Outpatient Surgery Magazine for a look at how your colleagues manage implant costs.

    —Daniel Cook

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