Outpatient Surgery Magazine

Marking Madness - April 2013 - Subscribe

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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Page 36 of 157

OSM560-April_DIGITAL_Layout 1 4/5/13 2:28 PM Page 37 1 The ASC must supply and purchase the IOL. The surgeon can't pur- chase the premium lenses for Medicare cataract cases and bring them into the surgical facility for use in the cases. This is a compliance issue on a couple of fronts. First, Medicare doesn't let the facility bill for cataract extraction CPT codes with the –52 Reduced Services Modifier. Second, there's no other billing method to convey to Medicare that the facility didn't purchase the IOL for the case and therefore shouldn't be reimbursed for the IOL. Because there's no provision to let the facility break out the IOL implant portion of the procedure from the cataract extraction CPT code, Medicare requires you to supply and purchase the IOLs for all Medicare cataract cases. No exceptions. Medicare considers it to be a false claim if you submit a claim for a cataract extraction case for which you're receiving payment for the IOL when you didn't purchase the IOL. 2 You can't reimburse your surgeon for the IOL. Medicare doesn't let the facility reimburse the physician for any IOLs the physician purchased. It bears repeating: Medicare requires ASCs to purchase and supply the IOLs for all Medicare cataract cases. 3 What can you bill the patient? What can you charge patients for the use of premium IOLs in Medicare cataract cases? Medicare directs what you can charge patients for the premium lenses. Keep in mind that you're receiving the $150 as payment for the IOL from Medicare as part A P R I L 2 013 | O U T PAT I E N T S U R G E R Y M A G A Z I N E | 3 7

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