Trying to Assess Reimbursement Impact based on Revenue Code Change.


A recommendation was made by our consultants to update Revenue Codes on implants from 272 to 278. We did our own research and confirmed that it made sense to do so. While it would not increase payments from Medicare, we were able to see wording in our commercial payers that executing the above recommendation could increase reimbursement.

Our contracts management team is new, we are using older technology and/or we are in process a obtaining the talent to answer the following question.

Until then, I was wondering would anyone know how to tell me a basic concept of how to create a quick net revenue impact analysis based on certain Implants (CDMs) that moved from RevCode 272 to 278?

P.S. I understand how hard it is perform Net Rev impact analysis since it is based on account... but wanted to ask here just in case.


Mike Shin


  • I am a novice in this but want to walk myself through. If the implants are in 272, the payers may not pay the line item as it seems to them to be a routine supply and they love to remove those from claims. So if you put it in 278, it won't automatically be removed and will be paid separately. Now to find out what you are losing, could you look at claims where a line item under revenue code 272 was written off or removed and quantify that? I have no idea if that is posssible and you'd have to determine which are really routine and deserve to be bundled and which should be paid separately but that seems to be how to tell.  
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