What reimbursement support tools are available for Hyalgan?
Lastly, reimbursement support tools such as sample claim forms, checklists, and template letters are provided to assist healthcare providers and staff when utilizing HYALGAN for patient therapy. Disclaimer
Who should seek reimbursement for outpatient care?
Any determination regarding if and how to seek reimbursement should be made only by the appropriate members of the physician office or hospital outpatient staff, in consultation with the physician, and in consideration of the procedure performed or therapy provided to a specific patient.
How to contact a reimbursement specialist for conducting patient-specific insurance benefit verifications?
To contact a reimbursement specialist for conducting patient-specific insurance benefit verifications, please call The HYALGAN Support Hotline at 1.866.7.HYALGAN (1.866.749.2542), Monday to Friday, from 9:00 am to 8:00 pm EST. Medicare
What are private payers’ restrictions on reimbursement?
Private payers may implement restrictions, such as requiring prior authorization and/or other utilization controls. Reimbursement may also vary significantly by the specific contracts that are negotiated between providers and private payers. Requesting plan-specific coverage information on HYALGAN is an important step in understanding your
What is a Hyalgan reimbursement guide?
The HYALGAN Reimbursement Guide is intended to provide current and available reimbursement information related to HYALGAN in the physician office and hospital outpatient settings of care when HYALGAN is administered as prescribed by a healthcare professional. In this document, coverage, coding, and payment for HYALGAN are reviewed for public (Medicare/Medicaid) and private payers. In addition, the reimbursement support and patient assistance services available through The HYALGAN Support Hotline are described. Lastly, reimbursement support tools such as sample claim forms, checklists, and template letters are provided to assist healthcare providers and staff when utilizing HYALGAN for patient therapy.
What is reimbursement in healthcare?
Reimbursement is the amount a payer renders to a healthcare provider plus patient out of pocket, deductibles and or copays for covered therapies and services. Typically, the payment methodology and payment amount vary based on the site of service where the care is provided.
What is coding in healthcare?
Coding allows healthcare providers and payers to communicate by translating medical terminology into defined
What is a local coverage determination?
Coverage Determination (NCD) or a Local Coverage Determinations (LCDs). CMS issue NDCs and Medicare Administrative Contractors (MACs) issue LCDs. LCDs are specific to a MAC’s jurisdiction and each state, meaning that specific coverage criteria for a product and its administration, as well as coding requirements, may vary by Medicare contractor. NCDs are rare for drugs and other similar products. Please consult your MAC to determine if any LCD apply to HYALGAN. To verify a patient’s Medicare
Where do physicians administer drugs?
physician administered drugs in the office and hospital outpatient settings.
When will ICD-10 codes be required?
As of October 1, 2015 ICD-10-CM codes will be required on claims.
Can you get reimbursement for third party medical services?
you will be successful in obtaining reimbursement. Third-party payment for medical products and services is affected by numerous factors, not all of which can be anticipated or resolved by the hotline.
