Coding and coverage are the pillars of reimbursement. Understanding these areas is important in order to assist billing experts when they submit for reimbursement.
Abbott annually updates coding and reimbursement information for hospital inpatient, hospital outpatient and ambulatory surgical center (ASC) settings, as well as physician rates. Click on our guides to easily look up CPT codes, ICD-10 codes, physician relative value units (RVUs), and Medicare national average reimbursement rates.
Most elective procedures must follow a process that allows providers to determine coverage and secure approval from a payer for a proposed treatment or service.
Not all procedures are approved, mainly due to missing information. Physicians and patients have the right to appeal a denial, which consists of both internal and external reviews.
Medicare is the largest public payer in the United States. Medicare is a public insurance provider with a rigorous approval process. All of their rules are posted for review.
This material and the information contained herein is for general information purposes only and is not intended, and does not constitute, legal, reimbursement, business, clinical, or other advice. Furthermore, it is not intended to and does not constitute a representation or guarantee of reimbursement, payment, or charge, or that reimbursement or other payment will be received. It is not intended to increase or maximize payment by any payer. Abbott makes no express or implied warranty or guarantee that the list of codes and narratives in this document is complete or error-free. Similarly, nothing in this document should be viewed as instructions for selecting any particular code, and Abbott does not advocate or warrant the appropriateness of the use of any particular code. The ultimate responsibility for coding and obtaining payment/reimbursement remains with the customer. This includes the responsibility for accuracy and veracity of all coding and claims submitted to third-party payers. In addition, the customer should note that laws, regulations, and coverage policies are complex and are updated frequently, and, therefore, the customer should check with its local carriers or intermediaries often and should consult with legal counsel or a financial, coding, or reimbursement specialist for any questions related to coding, billing, reimbursement, or any related issues. This material reproduces information for reference purposes only. It is not provided or authorized for marketing use.
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