Wiki Implants...plates, screws...

[Denise M]

Can anyone tell me what is the norm for billing out implants to insurance companies. Do you bill implant invoice price or raise the price from implant charge?

Thank you for any input.

Denise

 

[gsteeves]

Implants

It depends on the insurance company. Some of the companies are invoice only and others do give you a certain percentage that you can bump it up.

Hope that helps

 

[moeslilmom]

As long as you are billing the charges out consistently. In other words, you can't charge one insurance 3 times the price of the implants because they pay a percentage of what you bill, but only bill another the cost of the implants. I would come up with a formula that covers the top paying contract you have and stick with that across the board. For instance, marking up all the vendor invoice amounts for HCPCS C1713 by 150%. For those insurances that pay based on invoice cost, you would need to submit a copy of the vendor invoice with the claim. The insurances would then be responsible for any contractual adjustments. However, be careful to watch for overpayment procedures/guidelines outlined in the contracts. Most state you would be responsible for returning any overpayments.

Since the price of the implants usually depends on the quantity, type of implant, etc., marking up by a percentage would be the best option. However, if you only bill a few specific items out under a specific HCPCS code, then you can always just charge a flat-rate. The key will be consistency! The guidelines your practice or you implement when deciding what to charge has to be the same across the board for all payors, including self-pay.

 

[mswalker]

Look at your contract. For our ASC's most companies pay cost + %. We bill exactly that amount and include copies of the implant invoice, log, and operative notes.