PLACENTAL TISSUE ALLOGRAFT
REIMBURSEMENT SUPPORT FOR PATIENTS
Agents of Healing can refer physician customers to a third-party resource for Coding, Documentation, and Reimbursement Support. The following items should be completed for account set up: New Physician Account Form, Purchase Agreement with On-Line Ordering Information, Pricing, Terms, Shipping & Handling, Patient Education, and Product Information.
Reimbursement support services are provided by a third-party company and include the following but not limited to: Business Associate Agreement with Billing Company, Physician Practice Information Form, Patient Eligibility Verification Form, Coding, Documentation, and Reimbursement Overview and Support.
for Patients includes
Patient Education and
Verification, Coding, and
Documentation, will be
handled by a third-party
A message about Coding, Documentation, and Reimbursement support from our third-party biller, "The LCD for Placental injections are very different from Payer to Payer than we are used to. They list all of the Dx codes deemed 'medical necessary' and they trust you to diagnose and submit the codes for those conditions. That's not the case with Placental products, you MUST prove Medical Necessity by documenting care. In other words, documentation is crucial for the placental injection reimbursement. Please make sure your progress notes include the following: 1) Indicate in the HPI that the patient has undergone at least 90-days of conservative, traditional treatment. These may include, but are not limited to PT, Chiropractic, compression therapy, analgesic injections, opioids, etc. 2) Treatment done at other practices count, but only if you document the treatment history. 3) If the patient has not yet undergone 90-days of traditional treatment, indicate in the Plan of Care that you intend to use a placental injection if that patient fails to respond to conservative measures.
We provide Verification of Patient Eligibility for the injections as part of the program. Not all providers will cover the injections. We will work with your office to determine coverage, to ensure that you are in-network, and review whether the patient's deductible has been met.
There are several other important details that we will provide when Submitting the Claim. They may or may not include the following: number of units injected based on the appropriate Q code or HCPCS code being utilized, copy of the invoice with the cost of the product, appropriate diagnosis codes typically required, and supporting audits if needed of your medical records and documentation. In most cases, there will be a pre-payment audit the first few claims submitted to ensure compliance. Once the payer is confident your documentation and claims are in order, they will lift the review."
Please feel free to contact Agents of Healing at 866.866.1656 or email@example.com with any questions concerning reimbursement support for patients in your area.