Experiencing Insurance Denials?

INBONE™ Technologies - The INBONE™ Total Ankle Replacement System & The INBONE™ Fusion System INBONE™ Technologies has put together a Prior Authorization Guide to help your patients get approved in a timely manner. This package includes a sample letter of medical necessity, sample appeals letter, a flow chart of what to expect, and what you need to do if your carrier denies coverage.

You can request this package by calling 303-951-0242 or e-mail insurance@inbone.com.

Steps for the Prior Authorization Process

Collect Information

Patient name
Patient birth date
Insured name and birth date
Patient Id Number or Insured Id Number (often social security number)
Employer of Insured
Clinician’s name
Facility/Clinic where surgery will take place
Identify all diagnoses and cpt codes. IE: 27702 – Arthroplasty-ankle, with implant. DRG code 469 or 470 for Medicare/Medicaid/CMS. It is beneficial to include the DRG code on all claims, even if the insurer is not Medicare/Medicaid/CMS

Contact Insurer

Inquire about eligibility
Inquire about coverage for the INBONE™ Total Ankle System procedure
Determine insurer’s requirements for prior authorization

Verbal authorization may be given based on the above information, however, written aurthozation is preferred. For written authorization you will need to provide:

A Letter of Medical Necessity
Patient records - this may be included in your letter
The insurer may want more information on the Total Ankle System procedure. Provide clinical summary and journal articles (we have these available).
State why arthrodesis is not an option or is not viable, or if it has already been done. Insurance companies often state that arthrodesis is more common, so it is beneficial to explain why arthroplasty is the only option for you.
If you would like a list of insurance companies who already cover the procedure please contact insurance@inbone.com. This list changes constantly as insurance companies update their coverage status. It can be helpful for the insurance company to know who is already covering the procedure.

Send Requested Information

Gather the requested material, and fax or mail it to the person or department responsible for the prior authorization decisions. If additional educational materials on the INBONE™ Total Ankle System procedure are needed, please contact us.

Follow up

Continue to follow up with the insurer until a coverage decision has been made. Get the patient involved in follow up. They are the customer.

Re-Verify Eligibility

When prior authorization is granted, re-verify the patient’s eligibility to ensure that the patient is still covered under that particular insurer.

Appeal

If authorization is denied, the clinician and the patient should discuss the likelihood that the decision will be appealed. For an appeal, you will need to request information from the insurance company regarding the appeal process. Then send your appeal letter and the required materials as directed under FOLLOW UP
The appeal process can be timely, if the decision is made to appeal, it should be done asap. There are typically 2 – 3 levels of appeal and an IMR – Independent Medical Review.
It is beneficial to also include the HR department of the insured’s employer. They negotiate the contract with the insurance and what is covered or not covered so they can be influential

Disclaimer

INBONE™ Technologies routinely provides customers with information about appropriate coding of their devices. In our experience, information provided by INBONE™ Technologies in this manner can significantly simplify a provided or supplier's task in determining how to bill for these products. INBONE™ acquires confirmation of correct coding directly from CMS.

Accordingly, CMS and other payers, in reviewing for appropriate billing, will regard such information as, in general, reasonable support for a coding decision with respect to whether a payment was appropriate.

Listings of codes, whether diagnostic or procedural, represent those that may apply to that patient encounter. It is the customer's responsibility to determine which combination of codes from this listing actually applies to that specific patient encounter. Providers of services or items are ultimately responsible for the content of the bills they present to Medicare or any other payer.

Should additional questions arise about appropriate coding on an INBONE™ product that cannot be resolved independently, the appropriate first step is to seek clarification from INBONE™ by sending an email to info@inbone.com.

Please contact info@inbone.com for supporting documentation.