Wiki Synvisc Injections

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jerristokes

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Does anyone have any experience in getting paid promptly and adequately from payors by billing them directly for Synvisc Medicaton? In my past experience, we had a difficult time getting paid even enough to cover the cost.Typically, our patients get Synvisc medication through their health insurance and we do not stock it (except for Medicare patients). I welcome any input.
 
Your experience is the same as mine. The docs I work with in 4 different states just give the patient a script for the drug and have them pick it up at the pharmacy and then bring it into the office.
 
We currently purchase and administer Synvisc, Supartz, etc, injections. In my opinion, there is some labor receiving reimbursement from the carriers. First the carriers have edits in place for the medically necessary/accepted diagnosis codes. Then...the carriers have requirements for what constitutes medical necessity. Then...some carriers require documentation to ensure that the diagnosis and medical necessity are compliant with their requirements. Then and only then...after they scrutinize over our providers documentation, do they consider payment. Our providers are thoroughly educated on the criteria for medial necessity and even with this information, the carriers fight tooth and nail. And yes...the reimbursement can be low...even with negotiations.
 
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We have no issues and are being paid by all carriers except Medicaid. Reimbursement is not hugh but it does cover our cost.
 
No issues here as long as the pt has some kind of osteoarthosis because those are the only DX codes medicare will cover with synvisc.
 
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