Why Do You Need Spravato Billing Solutions?
Anyone aware of even the basics of mental illnesses would know the consequences of treatment-resistant depression can be far-reaching. Today, thousands of patients are eagerly awaiting their turn for help; to receive that one magic drug called Spravato to bring them solace and cure.
So, what is standing between the healthcare providers and the patients as a barrier to obtaining Spravato therapy? It is the unsolved complexities of the Spravato insurance coverage formalities. And, who can help you with it? The answer is simple—an efficient Spravato billing solutions provider.
Needs for Spravato billing solutions arise from the fact that there are no unique codes designated to validate the monitoring and observation provided to the patient after the administration of the drug. Since Spravato is administered following risk evaluation and mitigation strategy, valuable time of the provider is put into use in the direct observation of the patient, which also should be billed and standardized as a part of Spravato therapy.
Table of Contents
The Scope of Practising Spravato Therapy in the New-age Medicine
Spravato nasal spray was developed as a significant value addition to the treatment of major depressive disorders and suicidal ideations. With its novel mechanism of action, Spravato is showing rapid and potentially marked results with patients who were proved unresponsive to the current anti-depressant therapies with other drugs available in the market. At the same time, the therapy remains highly-priced for most patients and the providers are not able to administer it cost-effectively.
Moreover, there is the question of challenging insurance coverages for Spravato, which forces the providers to resort to out-of-pocket payments from the patients. Without the right ways to obtain insurance reimbursements for Spravato, access to this innovative therapy is denied to millions of patients. This is where the need for a Spravato billing solutions provider arises; to empower the healthcare providers to offer Spravato therapy to the maximum number of treatment-resistant depression patients while earning the right amount of claims at the same time.
Nuances Specific to Billing for Spravato Reimbursement
Spravato practice is different from other specialty practices in many ways. It does have any special requirements to fulfil before starting the practice or treating the patients.
For starters, one should have suitable healthcare settings at their facility to administer risk evaluation and mitigation type of drug administration. A licensed personal should be there at the site of care holding the approval from the drug enforcement administration. The drug is only available via very few authorized companies through the buy and bill program. The patient should be deemed eligible for the therapy by the authorities. The patient’s insurance plan should clear for Spravato coverage and lastly, the coding and billing information should be done strictly adhering to the insurance payer’s criteria to get reimbursed for Spravato, the codes being still vaguely defined.
Quite baffling for a newbie at Spravato practice, which is why one needs Spravato billing solutions in the first place, even before setting up a practice.
Why Spravato Billing Requires Support from External Agencies?
Considering the steps and challenges involved in launching a Spravato practice, it is only logical to plan and hire expert Spravato billing solutions to aid you with the right Spravato medical reimbursement solutions. With experience in the Spravato practice strategies and the right tools to dispense with, they can ease up the process for you in many ways.
Practolytics Spravato medical billing solutions is an all-comprehensive entity, especially working for practices that have specific needs of Spravato billing solutions. For the past 20 years, Practolytics has catered clinicians with profitable practices. Our goal is to streamline your billing process so that you receive maximum reimbursement with Spravato claims. Hand over your Spravato benefits eligibility checks and pre-authorization process to us and we will handle the responsibilities for you with utmost care and precision.
Also Read – 10 Ways to Improve Your Billing Process
How do Spravato Billing Solutions Assist the Facilities with Billing?
Let us look at how the needs of Spravato billing solutions at a Spravato practice are fulfilled by long-time experts in the field.
Authorizing the patient as eligible to receive Spravato therapy
The Spravato billing solutions can help you get the patient enrolled for the therapy by moving forward with the right steps in eligibility verification and benefits checks. The insurance payer is going to review the drug claim of the patient to determine if it is covered in the policy. There should be enough validation to support the medical necessity of the patient’s disease condition to obtain the therapy. The professional billers can advise the providers on how to go forward with the physician’s statement on medical necessity and diagnosis to ensure Spravato therapy is approved for the patient and is delivered as per the drug policies of the insurance company. In case the patient is labelled ineligible for the therapy, they can help you appeal for the patient.
At Practolytics, we help you define the eligibility of the patient at least two days before submitting the claim. After you prescribe Spravato for the patient, we proactively work towards preauthorizing them for the drug within the first five days. The patient can contact Practolytics at a toll-free contact number and seek clarifications regarding the eligibility verification status as well as billing queries. We can claim around 98% of successfully cleared eligibility verifications every month, which means your patients will not face treatment denials.
Authorizing the provider for Spravato administration
Site of care specifications are crucial to Spravato reimbursements. This makes it essential for a physician’s practice setting to be cleared for the requirements for Spravato administration as demanded by the authorities. The practice needs to be certified based on risk evaluation and mitigation strategy needs for ordering, receiving, storing, dispensing and treating patients with Spravato medication; another reason why need Spravato billing solutions at your practice.
Both the physician and facility need credentialing to launch Spravato administration and your professional biller can help you deal with all the formalities and paperwork concerning that. Apart from credentialing the provider for Spravato practice, Practolytics will help you in developing the right clinical protocols, streamlined with the insurance payer’s regulations, to reimburse for prolonged evaluation and management services.
Tackling the coding complexities concerning Spravato
Coding for Spravato can be quite tricky, but your professional biller will have everything sorted out for you. Right from obtaining the patient’s medical history, reviews, tests performed, evaluations, counselling sessions, ordering medications, educating the patient/caregiver, referrals to other health care providers, documenting clinical details, interpretation of results and coordination of follow-ups—everything is streamlined and reflected in the codes assigned so that you will never go unpaid for the valuable care rendered.
With Practolytics Spravato billing solutions, we always keep up with the ever-evolving usage of codes and billing criteria and other specific requirements to be met for reimbursing Spravato claims. Practolytics also offer complete software backup for Spravato billing. In collaboration with AdvancedMD practice management software and Osmind mental health billing solutions, we can take your Spravato practice to the next level of efficiency.
Apart from free software installation, support, and customization facilities, Practolytics provides free training to your staff on how to improve processes and enhance productivity. All your Spravato specific needs such as electronic health recording tools, online appointment schedulers, patient reminders, electronic intake forms, easy template builders, and DEA compliant controlled substance electronic prescriptions will be met by our Osmind and AdvancedMD practice management system. The patient mobile application for measure-based care therapy and outcomes, and engagement platform from Osmind will add value to your practice.
Treatment-specific claim generation for Spravato therapy
Billing a claim for reimbursement needs strategy and clarity since Spravato therapy is still not fully sorted out by the insurance companies—another reason why need Spravato billing solutions. The coverage criteria vary from payer to payer and one should be mindful of that to avoid denial. The diagnostic codes applied should be of the highest level of specificity and priority order. The providers administering and monitoring for Spravato should be billed appropriately based on the right codes for evaluation and management. The drug itself is coded based on the dosage which should be described clearly in the claim. With the help of automated claim generator software, billing solutions can enable you to send out the most comprehensive claims.
At Practlolytics, we make sure claims are processed and submitted in the fastest way possible daily. In case of claim rejections from the insurance company, we track them down from the clearinghouse at the earliest to rebill the claims. And if still the claims get denied, we report them to you every week and plan on an appeal equipped with clear legal grounds.
With long-term experience in the industry, Practolytics Spravato billing solutions can negotiate with the distributors specializing in Spravato to provide you with the best pricing possible. We hold re-negotiations with the insurance companies for better rates of reimbursements in terms of Spravato specific codes. Preauthorizing the patient for eligibility is faster and smoother with Practolytics so that you can commence the therapy without losing time.
Contact us without delay for an efficient start and better success at Spravato practice.