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Bariatric Beds Separately Reimbursed?

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klanger4778

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Minnetonka, MN
Hi All,
Does anyone know of any commercial plans that reimburse separately for use of a specialty bed during an inpatient hospital stay (for example, E0303)? I'm not referring to post-discharge, just during the hospital stay. I know it is not separately billable for Medicare and am trying to determine if United, Aetna, Cigna, etc. are consistent with that flat fee includes everything model.
Thanks in advance!
 
klanger4778 said:
Hi All,
Does anyone know of any commercial plans that reimburse separately for use of a specialty bed during an inpatient hospital stay (for example, E0303)? I'm not referring to post-discharge, just during the hospital stay. I know it is not separately billable for Medicare and am trying to determine if United, Aetna, Cigna, etc. are consistent with that flat fee includes everything model.
Thanks in advance!
Click to expand...


For an inpatient hospital stay, the commercial insurance is going to reimburse according to your contract with the insurer.

Generally, that will be a flat DRG payment. Many commercial contracts contain carve-out provisions for High-Cost Drugs and Impants, meaning that the hospital will receive the DRG plus a percentage of the line item for High-Cost Drugs and/or Implants.

I've never personally seen a contract that also has a carve-out for a specialty bed. (Prior to becoming a coder, I was a managed care reimbursement analyst, and I've reviewed hundreds of insurance contracts for multiple hospital systems.)

If you want to confirm whether any of your facility's insurance contracts would reimburse for the bed, I'd suggest checking with the contracting department to verify.

Good luck!
 
I would respond the same here. Though it's been a few years since I was involved in facility contracts, I've also never encountered a contract that had separate payment for a specialty bed on an inpatient stay. I think even carve-outs for implants are rare on inpatient contracts (you see these more often on outpatient surgery reimbursement) the only time I've seen carve-outs for inpatient reimbursement has been to large hospital networks that have substantial negotiating power with payers. Depending on your hospital's leverage (for example, if you are one of the few facilities in your region to offer this), you may be able to negotiate to have this written into your contract, but otherwise I would be surprised if any payer would offer it under normal circumstances.
 
Thank you both for taking time to respond to me. :) At least, at a minimum, reimbursement increases for morbid obesity with a DRG containing "with CC/MCC" when the patient's BMI is greater than 40 - of course they typically have other complications in that case so they would have it anyways, but if not, there's that.
 
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