Not Separately Reimburseable
I'm sure we have all experience denials for NSR.
I'm interested if anyone has found a great way to proactively deal with these. We are even seeing an NSR for an Impella Pump (very costly for those who may not know.) We appealed and the denial was upheld.
Impella pump was billed with a 272 revenue code on an inpatient claim. The claim hit a stop loss where the reimbursement would have been paid on percent of charges. Payer of course is looking for anyway to reduce charges.
Anyone have any suggestions?
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Came here to ask a similar question regarding "disallowed charges" - how are others getting around these denials? Are you just not charging separately for ANY supplies and rolling that cost into the room rate/procedure charge? Are you doing the same for POC glucose tests, saline, etc? Would love to hear from anyone who has successfully navigated these issues to ensure appropriate reimbursement.
I personally haven't seen an issues with the impella. We charge for those, and other high cost supplies like the ECMO circuits that have to be changed. Usually the NSRs for inpatient claims are more for services that they're arguing nursing can perform (a lot of respiratory).
POC tests are charged normally, and unless there's a quantity issue I haven't seen pushback on those.
Saline is set up to drop a $0 charged so it can be tracked, but it doesn't go to the claim. Same thing happens with any low-cost supplies, if they don't have a HCPC and are below our charging threshhold.