|
|
||
|
July 26, 2007 |
Vol. 1, Issue 1 |
www.surgicalreview.org |
|
|
||
|
July 26, 2007 |
Vol. 1, Issue 1 |
www.surgicalreview.org |
|
Seek Full Approval Now for Improved Reimbursement SRC’s Strategic Alliances continues to make progress with health care coverage for bariatric surgery patients. It is actively working with national payors and state agencies to obtain coverage for bariatric surgery and enhance existing coverage. For those major payors providing coverage, most now require the ASMBS Centers of Excellence designation for bariatric surgery reimbursement. So now is the time to start your process for Full Approval. The process is lengthy and one of the most rigorous in the industry. Once the site inspection concludes, the review process takes approximately 90 days iin most cases. SRC representatives are calling Provisional Status centers to discuss their application for Full Approval and make the centers aware of the various means that can help them in meeting the requirements, such as:Volume Averaging — For applicants who have experienced a recent decline in case volume due to insurance issues or natural disasters, the Bariatric Surgery Review Committee (BSRC) may consider the average of the case volumes for the two years prior to the 12-month period stated in the application and the application period. For hospital applicants, Full Approval may be granted at the discretion of the BSRC if the average is equal to or greater than 125. For surgeon applicants, Full Approval may be granted at the discretion of the BSRC if the average is equal to or greater than 50. The specific situation of each applicant will be considered including an explanation of the reason for the decline in volumes. Only cases of surgeons still operating at the applicant hospital will be considered in determining the average case volume for hospital applicants. Fast-tracking — The BSRC approved a proposal permitting the fast-tracking of applications in situations where a BSCOE surgeon has relocated to a non-BSCOE facility or for a BSCOE surgeon that is also affiliated with a non-BSCOE facility that desires to become a BSCOE. A non-BSCOE institution may apply with a BSCOE surgeon for Full Approval upon performing 63 cases (1/2 of 125) within the prior 6 month period. Full Approval will be granted if the circumstances indicate that the 125 minimum is likely to be met by the end of one year. There will be an automatic interim review at one year to verify that the 125 case minimum has been met. The hospital is still required to submit an application for Provisional Status and meet all other requirements. For more information, contact SRC Support or call 866.790.4772. |
||
|
©2007
Surgical Review Corporation |
||
