Let our data analysis help you increase your outpatient reimbursement for high-cost implants and other devices by eliminating the processes that burden revenue cycle departments the most–the cost of reworking denied claims and claims Returned to Provider (RTP).
Medicare has identified over 480 diagnostic or surgical procedures that are designated as “device dependent.” When Medicare processes the outpatient claim and it is working its way through the many OCE edits, these procedures require that a HCPC Level II device code be present on the claim, otherwise the claim will be “returned to the provider (RTP)” as unprocessed. This means zero payment until the claim is reworked. The provider must then allocate additional valuable time and resources to re-work the claim. This involves research to determine which device or implant was used (especially if a miscellaneous charge was entered) and then determine the appropriate HCPC level II code for the implant or device. Our goal is to provide you with a solution which results in your claim containing the valuable HCPC codes for implants and devices before it goes out the door.
HCPC Level II codes also play a crucial role in securing reimbursement for certain items that Medicare reimburses in addition to the comprehensive APC payment (procedures with a status indicator of J1). There are 14 different HCPC level II codes for devices and implants that are separately reimbursed by Medicare, over and above the comprehensive APC payment (status indicator J1 procedures).
For CY2022, Medicare has identified 14 implants/devices, 16 radiopharmaceuticals and 17 brachytherapy sources that are reimbursed in addition to the comprehensive APC payment. Accurate identification and the application of accurate HCPC level II codes to these items is crucial to bringing in the additional Medicare payment that due.
The Meperia item database contains of over 1.5 million unique manufacturer items. Over 530,000 unique manufacturer items have been identified as either implants, other devices, radiopharmaceuticals, or brachytherapy sources that require a HCPC level II code to help assist with meeting the outpatient claim edit for device dependent procedures and or to secure reimbursement for separately reimbursed implants/devices.
Contact us at email@example.com to learn how we can help you reduce outpatient surgical claim denials and rejections.
About the Author
Amy Larson, RHIT, CCS-P, is the Senior Coding and Reimbursement Analyst at Meperia. Her primary goals are to identify items meeting the criteria for HCPC Level II codes, allowing for improved outpatient facility revenue capture and reimbursement. Amy is a credentialed coder through AHIMA for over 29 years, having worked in many sectors of health care including, level 1 trauma inpatient and outpatient hospital coder, managed care PHO assistant director, consulting and has held positions as adjunct faculty instructing courses related to medical coding and reimbursement.