What would you say if I told you there's a no-fuss, no-muss way to purchase pricey surgical implants without adding to your case costs? Would you advise me to lay off the nitrous oxide? No need. I'm working with two third-party implant billing services that coordinate implant purchases and collect reimbursement payments, letting me host expensive cases with essentially no financial risk.
Implant billing services let you host cases that you otherwise wouldn't for fear that you wouldn't be reimbursed for the expensive implants they require. Here's how the services work:
- You contract with a billing service, giving it complete control over collecting implant fees.
- The billing company typically has relationships established with commercial payors and implant manufacturers. It helps coordinate implant deliveries to your facility and post-op billing.
- The physician's scheduler notifies the third-party billing service of an upcoming implant case and submits necessary paperwork.
- The billing service informs the implant manufacturer, which delivers its device to your facility before the scheduled procedure.
- The surgeon implants the device.
- The billing service takes ownership of the implant. It purchases the implant from the manufacturer and bills the commercial payor for its cost.
While the process involves a series of moving parts, your responsibilities are straightforward and easy to manage. On the day of surgery, the patient signs a waiver giving the third-party billing service permission to bill his insurer for the implant. You then provide the billing service with the patient's demographic information and the serial number of the implanted device. That's it you're off the hook for recouping the cost of the implant. Yes, you collect only a facility fee and forfeit any implant revenues to the third-party biller, but purchasing an implant you might not get reimbursed for is a risk many might not want to take. What you lose in profit potential when working with third-party billers, you gain in payment certainty.
Patients with in-network insurance plans present somewhat less risk to you, as contracts with those payors often specify implant reimbursement amounts. You can feel confident scheduling in-network implant cases knowing you'll get reimbursed and the exact amount you'll receive.
As most of you know, however, the reimbursement policies of out-of-network payors are at best unpredictable, and there's no way to be certain you'll get reimbursed in full for surgical implants. Sure, you can take the necessary precautions and make a best guess of your reimbursement chances, especially with commercial payors you've had success with in the past, but when working with unknown insurers the reimbursement game is largely hit-and-miss.
Using a third-party implant billing company takes the guesswork out of getting paid for the devices. Because payors and billing companies agree to one fee per implant, payors don't have to worry about negotiating varying payment schedules with facilities across the country. Implant manufacturers, meanwhile, contract with a national firm with the potential to generate, say, 500 implant charges a year.
The third-party billing companies also let smaller facilities host expensive cases they might otherwise pass on, which moves procedures from hospitals to surgery centers facing less overhead costs, a potential money-saving migration for the insurers.
Tips for doing it right
We first worked with a third-party implant billing service to manage pain pumps sent home with hand surgery patients. Our pain management physicians, and a vendor they worked with, soon expressed interest in bringing advanced pain procedures to our center. The implantable neuro pain stimulators used in the cases, however, cost as much as $20,000, an expense that essentially priced the procedures out of the facility.
The stimulators' manufacturer suggested we employ the services of the company handling our pain pump billing. I'm always interested in augmenting our service line with cases that interest our physicians, so with the help of the implant billing service I decided to take the plunge. Here are some tips to consider if you make the same leap of faith.
- 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. Most do and are more than willing to facilitate a meeting if it would help get their devices into your ORs. Working with parties who are familiar with each other will help the entire billing and payment process go as smoothly as possible.
- Work together. Before implanting a single device, 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.
Talk through the entire billing process. Who'll notify the billing service of an upcoming implant case? How will implants be delivered to your facility? What paperwork are you responsible for providing? What policies are in place if the third-party biller doesn't get reimbursed? That's an important topic to discuss. Make it known that third-party billing services should never balance-bill patients if they fail to secure reimbursement from commercial payors. Tell billing companies that you'll terminate their services if they contact your patients for payment.
- Rely on the schedulers. Physician schedulers know of upcoming procedures that require implants and will contact third-party billing services to gain approval for the implant and set the purchasing wheels in motion. By the time patients walk through your doors on the day of surgery, the necessary paperwork should already be complete.
No risk, big rewards
The number of implant cases is growing at a double-digit rate, thanks to improved clinical outcomes and increased surgeon demand. For some facilities, passing implant revenue opportunities to third-party billing services might outweigh the risk of not getting paid for the devices at all, and help expand a caseload limited by financial restraint.