A steady and sustainable stream of revenue is integral to the health of any practice. And often, revenue hinges on the ability to secure timely reimbursements, especially for expensive products like IVIG. If you’re like most physicians, you know all too well how challenging IVIG purchase reimbursement can be.
From payment denials to nuanced processes, unsuccessful IVIG purchase reimbursement efforts can hurt your bottom line. To ensure speedy and accurate IVIG purchase reimbursement, you must be well-versed in MACs, relevant codes, and reimbursement files.
What are Medicare Administrative Contractors (MACs)?
Acquiring an in-depth understanding of the role and function of a Medicare Administrative Contractor (MAC) is critical to managing your practice’s or center’s IVIG purchase reimbursements. MACs essentially acts as intermediaries between healthcare facilities and Centers for Medicare and Medicaid Services (CMS). All financial transactions are submitted by healthcare facilities to MACs to be processed for payment. MACs perform a host of time-sensitive and critical tasks including:
- Submitting and accounting for Medicare FFS payments
- Processing, Medicare FFS claims
- Enrolling providers in the Medicare FFS program
- Managing provider reimbursement services and provider cost reports
- Overseeing and responding to redetermination requests (first stage appeals process)
- Responding to provider inquiries and teaching providers about Medicare FFS billing requirements
- Establishing and communicating local coverage determinations (LCD’s)
- Reviewing medical records relevant to specific claims
- Coordinating and communicating with CMS and additional FFS contractors
As you can see, MACs play an essential and decisive role in IVIG reimbursement and process over 1.2 billion Medicare FFS claims each year.
Using the Right Codes
The importance of using the right medical codes when it comes to submitting an IVIG purchase reimbursement claim is often underestimated. Precise medical coding is significant on many levels, among the most notable being its role in helping to maintain accurate patient records reflecting the treatment, care, and medications administered. Proper medical codes are also necessary to guarantee correct payment to physicians for services rendered. Failure to reference the right code may lead to delay or even denial of payment.
Medical coding is a complex and specialized asset for all healthcare organizations, regardless of size or patient population. Simply put, coding is the operational channel between coverage and payment. To ensure favorable and expeditious IVIG purchase reimbursement outcomes, you should employ an experienced medical coding service provider with a proven track record of quality and accuracy.
Estimating Your Reimbursement
When it comes to reimbursement, the only constant is change. In other words, reimbursement for the physician office and hospital outpatient facilities changes all the time. CMS provides reimbursement based on the Average Sales Price (ASP), which is calculated using manufacturer sales data. With fluctuating market conditions, new products emerging, and price shifts, it’s not surprising that reimbursement for some medication increases, while it decreases for others.
In addition to reviewing informative and updated resources such as CMS’s quarterly reimbursement drug file or ASP guides provided by the U.S. Department of Health & Human Resources, you need a trusted partner to answer your questions and ensure that you get the reimbursement that you deserve.
With so many factors to consider and effectively manage with ROI in mind. As a provider of this service, w, contact us today to learn more. It’s not what you’re paying; it’s what you’re getting paid.