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Welcome to Global Integrated Reimbursement Services’ blog. The purpose of our blog is to allow access to a repository of issues that our company tracks regarding the reimbursement for pharmaceuticals, medical devices, diagnostics, biologics, and biosimilars. Also, it shows you how we can assist you in these areas.

GIRS’ Six Tips for Successfully Adopting a Medical Technology Contact Support Center

Posted by on Nov 16, 2016 in Hotline Successes | Comments Off on GIRS’ Six Tips for Successfully Adopting a Medical Technology Contact Support Center

Within constantly changing payer landscapes and payer requirements, a reimbursement hotline staffed with dedicated reimbursement experts bridges the gap between providers, manufacturers, and payers. Such a dedicated reimbursement team can play an invaluable role to educate providers on submitting clean claims, appealing denials of coverage and payment, as well as other payer requirements. Selecting such an expert team to help providers stay informed of your Product’s coding, billing, and coverage requires careful consideration. The following is a list of tips to help guide you in your decision. Tip #1 – Verify the contact center employs sound standard operating procedures (SOPs), Protected Health Information (PHI) policies, training and implementation programs and staff members that are knowledgeable and passionate about policy and compliance. Tip #2 – Ensure that call center staff training focuses on competent provider support that will in turn...

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GIRS Successfully Supports Client and their Accounts to Avoid the Top 10 Errors In Medicare Part B Claims Submissions

Posted by on Oct 7, 2016 in Hotline Successes | Comments Off on GIRS Successfully Supports Client and their Accounts to Avoid the Top 10 Errors In Medicare Part B Claims Submissions

Novitas Medicare Part B, the Medicare JL contractor for providers in the District of Columbia, Delaware, Maryland, New Jersey and Pennsylvania posted the most common reasons for Part B claim submission errors for September 2016. Some key reasons and how GIRS assists our clients’ accounts to avoid these errors are presented below: Non-covered charges. Duplicate claim service The benefit for this service is included in the payment or allowance for another service or procedure that has already been adjudicated Payment is denied when performed/billed by this type of provider Claim not covered by this payer/contractor The procedure code is inconsistent with the modifier used or a required modifier is missing The GIRS InContact Reimbursement Line™ develops Billing Guides and Coding verifications are conducted to verify codes and modifiers with payers. The InContact Reimbursement Line™ also assists accounts to conduct...

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2014 Hotline Success Case Study 4: Sales Force Education

Posted by on Oct 16, 2014 in Hotline Successes | Comments Off on 2014 Hotline Success Case Study 4: Sales Force Education

  A sales representative from Illinois contacted the GIRS InContact Reimbursement Line™ to obtain the product billing and diagnosis codes for a device / biologic combination so that she could relay them to an account.  The counselor informed this  caller that the helpline cannot provide diagnosis codes; it is the responsibility of the providers to make that determination. The counselor provided an overview of the approved Product coding.  The counselor asked for permission to speak directly with the account to discuss coding and provide supporting materials.  The counselor also advised the sales representative not to engage in reimbursement discussions with or provide any guarantees of coverage and payment to the accounts .  The outcome of this case was that we had a satisfied and educated sales representative who was grateful for the support and education.  The account now has a direct...

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2014 Hotline Success Case 3: Account Education, Successful Verification of Benefits and Pre-determination Assistance

Posted by on Oct 16, 2014 in Hotline Successes | Comments Off on 2014 Hotline Success Case 3: Account Education, Successful Verification of Benefits and Pre-determination Assistance

The GIRS InContact Reimbursement Line™ found that an Insurance Verification Request (IVR) did not have the primary payer information for a case.  The hotline worked with the account by educating them on the IVR and the importance of providing the key data. The account then updated the IVR information and the hotline was able to use the updated information to verify coverage based on Pre determination.  The hotline then followed up with the account and the payer to ensure that the Pre determination was submitted by the account within the specified timeline and with the payer-requested information.  The reimbursement support service provided by the hotline helped the account to verify benefits prior to treatment and also to ensure that they follow all payer guidelines for claims...

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2014 Hotline Success Case 2: Successful Operation of Hotline to Support Medicare Coverage with Evidence Development (CED)

Posted by on Oct 16, 2014 in Hotline Successes | Comments Off on 2014 Hotline Success Case 2: Successful Operation of Hotline to Support Medicare Coverage with Evidence Development (CED)

The Global Integrated Reimbursement Services (GIRS)  InContact Reimbursement Line™ conducted a benefit verification with a Medicare supplemental plan for a patient enrolled in a Medicare National Coverage with Evidence Development (CED) study.  We found out that the Product was covered and the patient had zero responsibility for copayments and coinsurance.  The detailed and specific guidance on all the requirements for claims submission provided to the facility assisted them in meeting the payer needs for claims submission and the processing of...

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2014 Hotline Success Case 1: Prevented Billing with Incorrect Codes, Leads to the Assignment of a Specific CPT Code

Posted by on Oct 16, 2014 in Hotline Successes | Comments Off on 2014 Hotline Success Case 1: Prevented Billing with Incorrect Codes, Leads to the Assignment of a Specific CPT Code

For a device / biologic billed with an unlisted J code, competitors and coding experts were recommending the incorrect codes. Providers who participated in Coding Blogs and reviewed Coding Newsletters  were  resistant to our client’s Billing Guide and The Global Integrated Reimbursement Services (GIRS)  InContact Reimbursement Line™ guidance to accounts on the appropriate codes.  The use of incorrect codes could have lead to increased risk of audits for providers. The President of GIRS met with the American Medical Association (AMA) staff and requested guidance be published on the codes to educate providers.   We also met with the Coding News Letter Editor and educated them of the appropriate codes. Accounts were constantly educated on the appropriate codes and the AMA guidance was provided to accounts through the InContact Reimbursement Line™. To clarify the coding , the AMA staff themselves drafted a...

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