lines and payer contract coverage is critical in knowing when you'll be
reimbursed for these services.
Implants and supplies. Implants, high-cost supplies and medica-
tions used during a case are valuable sources of revenue for your
facility. They can be a determining factor in the overall profitability of
your cases and, really, the financial success of your center. For implants
and high-cost supplies, have a policy that establishes thresholds for
what's considered billable. An example: All implants, regardless of cost,
are captured on each case and communicated to billing, while high-cost
disposable supplies (drill bits, ablators, suture passers and blades, for
example) must meet an individual cost of $200 each unit to be captured
for billing; anything less than $200 per unit would be absorbed in the
case cost and standard fees for the case.
Determining what makes sense for your facility will depend on your
payer mix, payer contracts and specific payer guidelines. As an exam-
ple, Tricare will reimburse a surgery center for dispensed medications
with a cost above $40. Tracking these medications and ensuring that
they're billed would be key to a Tricare-heavy center.
Canceled cases. Whether they're canceled before or after you
administer anesthesia, canceled cases are often billable and, in
the majority of cases, reimbursed by government payers and covered
under payer contract terms. If a case is canceled before you adminis-
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identifies the items and services being used for that procedure —
all the supplies and implants needed for an orthopedic case, for
example — and review every item with the billing team to make
sure you're capturing every dollar per your agreement with the
payer. — Rebecca Geise
