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How an Experienced Spravato Billing Provider can Boost Your Revenue Cycle

Are you a competent healthcare provider aspiring to introduce Spravato therapy at your practice? Or, have you already done it but now are facing challenges with Spravato billing and revenue cycle management? If your answer is yes to either of those questions, then this article is for you. Today, we will look at how to set up, go forward and successfully manage a Spravato practice.

A smart Spravato biller is all it takes to sail through the complexities of Spravato billing process and ensure a smooth and streamlined revenue cycle management handling. Spravato is becoming increasingly popular among mental health professionals for its effectiveness and success rates. Therefore, it is high time we look into ways for a better, smoother and smarter Spravato practice management strategy.

What makes Spravato practice stand out among other specialties?

Today, Spravato has become a bright ray of hope for millions of Americans ailing from treatment-resistant depression. As a practitioner, how many times have you diagnosed a patient with severe depression and mood disorders, but were unable to help them despite trying more than two medications and other management strategies? Studies have shown that Spravato has effectively improved the mental health of patients with treatment-resistant depression. Both healthcare providers and patients are looking forward to better available and easier treatment options for Spravato in the future.

But as of now, things are not going smooth for those who are practicing Spravato therapy at their facility. Being an old drug but equipped with a change of face to serve a different kind of application, how to bill and reimburse for Spravato is still an enigma for the patients, practitioners and insurance companies alike. This is where the importance of Spravato biller is realised.

Complexities faced while billing for Spravato

What makes the Spravato practice different from the other specialty practices are these two crucial steps—obtaining benefits eligibility and prior authorizations.

Pre-authorizing the patient requires a detailed review of the coverage information of the patient’s insurance plan. Also, there will be an evaluation on the medical necessities that make the patient eligible for receiving Spravato therapy. The provider has to submit all the details on the patient’s disease condition, Spravato dosage needs, treatment history that proves the patient has treatment-resistant depression and other data adhering to the guidelines of the insurance provider. In case, if the review takes a negative turn and labels the patient ineligible to receive Spravato, the provider has to go forward with an appeal process to get it cleared—quite a difficult scenario.

Apart from other specialties, Spravato practice needs certification from the authorities with respect to the healthcare settings at your facility. It is so because the drug is administered based on risk evaluation and mitigation strategy. Therefore, to obtain, dispense and administer Spravato to patients, one has to provide direct supervision and observation on each sitting.  And, currently, there are no designated codes to validate the observation and monitoring process after administering the drug, which demands expert billing skills to capture charges.

Moreover, since each patient’s coverage varies according to their insurance payer and criteria, the healthcare provider has to consult the payer every time to sort out the details on coverage. It requires an experienced Spravato biller to clear it out fast and efficiently enough to go on with the treatment in such a way that both the patient and provider benefit financially.

Also Read: Why Do You Need Spravato Billing Solutions?

Balancing the revenue cycle Spravato-based reimbursements

To achieve the right balance in the revenue cycle management with Spravato-based reimbursements, you need an end-to-end solution to troubleshoot all the complexities related to Spravato practice. Be it for eligibility checks or pre-authorizing the patient and the provider for therapy, you need the best Spravato biller to successfully manage the practice.

Being the largest medical billing company, Practolytics can provide you with the right solutions to balance your revenue cycle with Spravato practice. At Practolytics, we negotiate for the most suitable pricing with all the main distributors of the drug to aid the providers with the Spravato buy-and-bill program.

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How can an experienced biller help you with Spravato reimbursements?

  • Pre-authorizing the patient as eligible to receive Spravato

When you hire Spravato biller, they can help your patient in getting prior authorization to deem eligible to receive Spravato therapy. It is important to meet the clinical criteria as per the insurance company guidelines to guarantee payment coverage. If the clinical criteria are not met, your biller can help you submit a letter of medical necessity on behalf of the patient. In case of adverse decisions from the insurance payer, an expert biller can help you and your patient appeal for re-considering the request for eligibility determination.

Since Spravato therapy is an ongoing process involving multiple visits and therapy doses, the pre-authorization process needs to be repeated every time. Your biller can keep track of the period of authorization and re-authorize the patient every six months, which is the designated period of approval right now.

  • Credentialing the provider for Spravato administration

There are quite a few licensing steps involved at the facility level and provider wise, in setting up a Spravato clinic. According to the State and Federal regulations, the treatment center is held accountable for all the elements specific to the treatment process along with storage, and inventory handling of Spravato. Trust your biller to walk you through the process with all the necessary certifications and approvals. One of them is the license to provide risk evaluation and mitigation service, another one is a license from the drug enforcement association to dispense the drug at your facility.

With the buy-and-bill model of drug purchase, an expert biller can negotiate with the Spravato suppliers in their network and help your patients avail of the treatment at minimum possible rates. This way, the out-of-the-pocket charges would stay minimal for the patient and the cost will not come in their way of obtaining the treatment.

  • Handling the coding intricacies specific to Spravato billing

When the drug is purchased and dispensed at the facility, the codes assigned for Spravato administration and the ongoing monitoring are handled separately by the biller. Since it demands direct observation and monitoring from the provider, it needs to be coded as per the guidelines of evaluation and management services. It is crucial that you appropriately implement codes specific to the patient’s condition and services provided, and stick to the specific requirements of the insurance payer and local payment policies. Here lies the importance of an experienced Spravato biller as they can help you in converting all the valuable services provided into valid codes for maximum reimbursement.

  • Treatment-specific claim generation for Spravato reimbursements

Spravato reimbursements can be optimized by the expert use of code modifiers. Your professional biller can help in increasing the coding accuracy and fortify the reimbursement. With high-quality healthcare records and claim generator software, the claim will have all the diagnoses listed in the order of priority, and codes of highest specificity so that you receive maximum reimbursement in the shortest time frame. It is a win-win situation for you and your patient.

Benefits of outsourcing Spravato billing to external billing services

Are you still wondering why need Spravato biller for your practice? Here are some added benefits of outsourcing the billing part to an experienced biller. With billing services, you get a complete software solution to manage your revenue cycle. Joining hands with cutting-edge technology practice management solutions and electronic health record systems will only boost the growth of your practice. Other benefits include online schedulers, patient reminders, patient care phone applications, user-friendly template builders and outcomes and engagement platforms.

At Practolytics, we hold contract negotiations with the insurance companies to make sure that you receive maximum rates at reimbursement with Spravato specific codes. As already established, we pass roughly 98% of all our Spravato bills every month and around 1000 patients are getting better services at clinics collaborating with us. And, now, with the AdvancedMD practice management system and Osmind software solutions, we are more empowered than ever.

With Practolytics, you get all the necessary assistance customized to the needs of your practice along with staff training and software support—free of cost. Look out for these special features such as Osmind electronic health record system, Osmind outcomes and engagement platform, patient mobile app for measured based care, AdvancedMD practice management system and electronic health record documentation, online appointment schedulers, automated patient reminders, electronic intake forms, Osmind’s controlled substance prescription facility compliant to the drug enforcement administration regulations, specially designed for treatment-resistant mental health practices.

As a mental health professional, you would have seen many patients who have tried every available anti-depressant medication with no apparent cure. Spravato is a new found silver lining to their state of despair and acute suicidal ideations. With experienced Spravato billing services such as Practolytics, you can support your patients as you have always wanted to and enjoy a hassle-free revenue inflow from Spravato reimbursements at the same time.

Also Read: Role of Medical Billing Software in RCM Services