Benefits of Possessing an Appropriate Spravato Billing Guide

The Spravato Billing Guide is a tool to assist providers on all aspects of going forward with a profitable Spravato practice. Here is how it helps;

• Assistance with Eligibility Verifications

The Spravato billing guide says, make your case full-proof to ensure the patient meets eligibility criterion for receiving Spravato. For this, one can take assistance from a professional Spravato biller to do the documentation part. With all the right documents properly attached to the application, chances of getting disapproved for the treatment are minimal.

Having said that, documentation for meeting the eligibility criteria includes the following: 

• Patient’s medical history with previous diagnosis of depression
• Proof and record of having undergone unsuccessful therapy with more than two antidepressant drugs
• Details of all diagnostic tests conducted to validate this diagnosis
• Appropriate documents on referrals to the current provider
• The detailed prescription specifying the treatment plan, dosage and duration of Spravato administration 
• All documents duly signed and authorized by respective providers

In case the patient is deemed ineligible for receiving Spravato therapy, the provider may help the patient further with request to reconsider. Sometimes, it is required to submit additional documents to make the case. 

• Benefit Plans and Coverage Verifications

The Spravato billing guide, navigates you on making the right investigation on the patient’s insurance package. This is a particularly important step to go through, right before going forward with drug purchase.  

Often, the insurance companies have denied the claim for Spravato related services just because the patient’s pharmacy benefits or treatments were not covered. Hence it is very crucial to verify the benefits in the given package.  This in turn helps the providers to give a heads-up to the patient about the breakdown of treatment cost according to their subscribed insurance plan. 

• Assistance with coding and claim submission

Now, the Spravato billing guide is highly specific when it comes to coding for the services provided. For one thing, the drug requires prolonged periods of evaluation and monitoring from the provider’s part. It also requires REM-strategy clinical set up and a DEA licensed provider for administering. After fulfilling all these requirements, assigning the right codes that represent all the eservices rendered is the most relevant part of billing for Spravato. 

The billing invoice must contain date and place of service, which is mandatory. And the evaluation/monitoring services also pertain to certain codes specific to the insurance payer. The biller should make sure that the coding criteria is compliant to the billing policies of the respective payment provider. Now, Spravato billing guide suggests appropriate use of code modifiers as well, to represent all the services provided. 

• Patient Support System

This includes implementing patient portals and tele-support helplines. Spravato clinics can take the assistance of a good Spravato support service to educate the patient through their person-to-person interactive support systems and personalized educational materials. This way, patient will have more clarity on what to expect while going through Spravato therapy. 

Since the payment policies and reimbursement strategies regarding Spravato is quite unique, it is very important patient is made aware of their financial responsibilities from the beginning. Now, having a Spravato billing guide handy, will help you with that.  Gives the patient more options to choose from regarding making the out-of-the pocket payment for purchasing the drug. 

To sum up, the goal of a Spravato billing guide is to make sure the providers are well-benefited from their Spravato practice and patients receive optimum care.