Wiki Hospitals billing for Open but Unused supplies and implants

[MRKOCUREK]

Medicare Program Memorandum A-02-129, which is based on devices with pass through status, instructs hospitals to report wasted implants on the patient bill in the following cases:

• Implant has been inserted and then removed
• Implant insertion attempted, but unsuccessful during a patient procedure.

We would not be able to bill for:

• An implant that has not been in contact with the patient
• An implant that was opened, contaminated or the wrong size but was not used.

Does anyone know if this guideline is still in effect? Is anyone else billing for these implants? Please, everyone’s comments are welcome

 

[gdicrocco]

Unused implants

I have a similar question.

We use a bisected patella implant for knee ligament reconstruction surgeries. It is a time sensitive product with a short shelf life…so we cannot order it and keep it available.

Several times the implant was not used, and we are obligated to send it back to the company at a cost of $50 to $100 for Fedex overnight.

If a special product like this is ordered for a specific patient/case and there is a cost when it is not used is that cost billable? Does it depend on if it was "opened" or not?

Any input would be greatly appreciated.

 

[JMeggett]

It's my experience that this is a carrier specific situation. Each insurance has it's own rules on whether these unused implant items are billable or not, or I should say "reimburseable" or not. I called the Provider Relations Dept at some of our highest payors and 2 out of 4 said they would reimburse on those items, with attached Invoice and explanation of WHY it wasn't used or left in patient. I'm sure there would have to be an Appeal letter submitted before the reimbursement actually happened...but it is do-able. So my advice is to check with the carriers you want to submit to and see if it's worth the effort! Good luck!

Jenna