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Billing Hardware for ASC?

  1. #1
    Coeur D'Alene, Idaho
    Question Billing Hardware for ASC?
    Medical Coding Books
    I'm wondering what everyone does to bill for hardware (screws, plates, etc) in an ASC setting (Physician owned)? I know that most insurances write them off and consider them to be part of the global fee.

    We've been tossing around the idea of using the ABN for Medicare patients, and a similar form for private insurance patients to allow us to bill the patient for the hardware we use in their procedures.

    Is this ok? I know we can go back to the drawing board and negotiate with the private insurance companies to allow payment for hardware, but is there anything we can do in the meantime until our contracts are up for renewal?

    Any advice would be helpful!

  2. #2
    We write them off as well; and we don't use the ABN because Medicare consider these hardware, etc included in the procedure so the patient is not responsible.

  3. Default
    We only perform EGDs and Colonoscopy in our ASC. Sorry we can't be of any assistance.

  4. #4
    We write them off as well . Its a shame though. Sometimes it cost more than the procedure. I just dont get it.

  5. Default
    We get paid on most of our implants (with the exception of Medicare, Tenncare) due to our contracts having a "carve-out" for implants with most of our insurance companies.

  6. #6
    Philadelphia, PA
    In our ASC we setup contracts w/Aet, UHC, Cigna, etc.. we do get paid for these, however we carved them out in contract, so otherwise you get nothing...Worker Comp also will pay us. Of course not Medicare except for the NTIOLS, if you do cataracts. I do believe an ABN is not an option.

  7. Default
    Ashley, we also bill alot of hardware implant items out of our ASC and write off the Medicare ones. We do have "carve-out's" on contracts with 5 of our biggest payors and so get reimbursed on most of our implants. I suggest you make friends with your Provider Representative's at your biggest payors and find out the earliest that your practice can get the chance to negotiate those ASC contracts. Good luck!

  8. #8
    Coeur D'Alene, Idaho
    I guess we'll have to go back to the drawing board with our insurance contracts then! Thanks for all of the input!!

  9. Wink
    We have carve out with some payors and we billed under 99070, w/c carriers they paid with copy of invoice, on Medicare we try not to use any implants, but if we do we writte them off.

  10. #10
    Ashley--fire whomever negotiated your contracts for not knowing what they were doing. They have cost your center a TON of money!!! Medicare/Medicaid and medicare replacement plans SHOULD be the only carrier that you should have to write off. Implants are generally paid quite well with the appropriate negotiations.
    Mary, CPC, CANPC, COSC

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