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Synvisc Injections

  1. #1
    Default Synvisc Injections
    Medical Coding Books
    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.
    JS

  2. #2
    Location
    Columbia, MO
    Posts
    12,867
    Default
    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.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Location
    North Carolina
    Posts
    3,126
    Default
    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.
    Last edited by RebeccaWoodward*; 07-06-2009 at 06:25 PM.

  4. #4
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    We don't have issue with receiving payment, but it is barely at our cost, which is unfortunate.
    Lisa Bledsoe, CPC, CPMA

  5. #5
    Default
    We have no issues and are being paid by all carriers except Medicaid. Reimbursement is not hugh but it does cover our cost.

  6. Default
    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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