Wiki Is there a way to see if any actual reimbursements made by Commercial Payers for a Category III code

Create Wiki
S

Sullivdr

New
Messages
9
Best answers
0
Is there a way to see if any actual reimbursements made by Commercial Payers for a Category III code?
 
Hi there, I don't know of any payer that publishes that information. A relevant specialty society might have some information on whether private payers are paying for a service.
 
I agree with @jkyles above. Additionally, not all provider contracts are the same. Larger healthcare systems often have non-standard contracts which could change whether or not a specific service is reimbursed.
 
I don't know if this is the issue, but: If a sales representative told you that a Cat III code is being paid, you need to do a ton of homework to confirm that it is true. I've seen literature from companies that bends the truth a lot or is just not true. (This is the case for permanent codes as well.)
 
In most cases, the relevant specialty societies have no information about this. It is HIGHLY variable to the point of being arbitrary, and each regional payor and MAC make their own decisions.
 
NRaizman said:
In most cases, the relevant specialty societies have no information about this. It is HIGHLY variable to the point of being arbitrary, and each regional payor and MAC make their own decisions.
Click to expand...
They may know, but because it's so variable they don't speak to it since it could change depending on the practice and provider.
 
rachaelwilleford said:
They may know, but because it's so variable they don't speak to it since it could change depending on the practice and provider.
Click to expand...
I cannot speak for every specialty society. For those with which I am directly and intimately involved,ASSH and AAOS, I can assure you this is not data we have any way of systematically collecting, and because of the large number of Payors and MACs, all with different policies that very by state, the data is nearly impossible to obtain. I have had conversations with RUC advisors from many specialty societies and this remains true across the board. Even device reps whose companies pursued the Cat 3 codes seem to have very little systemic information.
 
NRaizman said:
I cannot speak for every specialty society. For those with which I am directly and intimately involved,ASSH and AAOS, I can assure you this is not data we have any way of systematically collecting, and because of the large number of Payors and MACs, all with different policies that very by state, the data is nearly impossible to obtain. I have had conversations with RUC advisors from many specialty societies and this remains true across the board. Even device reps whose companies pursued the Cat 3 codes seem to have very little systemic information.
Click to expand...
Does ASCO collect info on Cat 3 reimbursement? If so, how?
 
You must log in or register to reply here.
Top