The reimbursement for intrathecal drug therapy is a very complex process. I wanted to take some time to answer the question that I have been increasingly receiving, “What the heck is going on with reimbursement?” Therefore, I want to provide information regarding reimbursement issues to ensure proper payment for the treatment of your patients. One of the unique things about intrathecal therapy reimbursement is that it is extremely complicated with its various codes, diagnoses, treatment policies, and reimbursement rates. Overall, there is a lack of consistency with reimbursement from various insurance companies, third party payers, Medicare, and so forth. Administrative bodies have different policies/procedures for reimbursement, and if they are not adhered to they can delay or even deny proper reimbursement for services rendered. In today’s world, this is something that requires you to pay close attention, and perform diligence.

Recently, we have heard of a few compounding pharmacies that are currently billing Medicare on behalf of the patients and physicians they serve. It is Hartley Medical’s understanding that this is improper activity contrary to Medicare policies, and Medicare has issued several “desist” orders regarding this practice. We have selected to, and are currently doing, research into this topic. If we find that providing Medicare billing services on behalf of those we serve is ethically appropriate, then Hartley Medical will happily institute this service. Until that time, though, we will not act in ways that may be inconsistent with Medicare policies. After all, we want to provide superior service ““ which includes looking out for you and your patients.

So what is our advice for you? Follow and research your reimbursement to ensure proper payment, and examine reimbursement versus costs of goods to ensure profitability. I encourage you to seek counsel, or advisors ““ such as individuals from Medtronic, the various insurance companies, or even through Hartley Medical. By reaching out to these individuals, you can eliminate problems and ensure good cash flow. Do not look away for your reimbursement. I am increasingly hearing providers saying that they have a problem … but the problems have been going on for over a year. Perform due diligence ““ look at reimbursement on either a monthly or quarterly basis to ensure proper remuneration and also profitability.

If you have any questions regarding reimbursement, please consider Hartley Medical as a source.



Please find this article and more in The Hartley Standard – Hartley Medical’s bi-monthly newsletter. Click here to read the September – October, 2011 edition.