External Counterpulsation Therapy (ECP and EECP) has experienced many changes in reimbursement since first approved by Medicare in 1999. Providers of ECP and EECP Therapy have discovered that policies for reimbursement can vary from one region to another as does payment from one carrier to another.
With great anticipation to the “Affordable Care ACT”, many providers of ECP and EECP Therapy wonder how the current healthcare changes will affect their payments in 2014. We are pleased to announce that after final review, the final reimbursement rates for 2013 are quite positive. The overall payment rates for External Counterpulsation therapy remain virtually the same only fluctuating 3%-5%.
Reimbursements impact for 2014
There is no question that payments in Cardiology are changing in the U.S. With so many cuts in diagnostic imaging (ultrasound, nuclear etc), ECP Therapy still remains a sound investment. In our estimation, ECP and EECP will remain a sound investment in the future due to the nature of the treatment being effect at a much lower cost to Medicare and insurance companies. ECP is also ‘protected’ in a sense because the treatment is generally provided exclusively in Cardiology and the treatment cannot be abused. As a safe, low cost treatment option for many cardiac patients, we predict this year to be another successful year for patients and providers of ECP and EECP Therapy.
ECP & EECP Reimbursement Suggestions for 2014
In order to run a seamless External Counterpulsation Therapy program, we can make some suggestions to avoid and delays or interruptions in payments for ECP and EECP.
1. Be sure to have a written attestation or summary in the patient file summarizing the condition of the patient. Be sure to document that the patient has CAD, the symptoms of the patient and the reason for ECP therapy (inoperable). Referencing objective diagnostic testing such as stress test, nuclear perfusion scans, angiograms etc as evidence of CAD.
2. We recommend that you use the global billing code rather than component billing. Global billing will minimizes any delay or lag time in payment, plus it minimizes any exposure. Be sure to follow this billing structure for both Medicare and third party billing
3. You are usually better to bill on a daily basis rather than weeks or more at a time. Most facilities comply with this rule but in the new cost cutting environment of today’s healthcare, it is better to bill lower amounts more frequently than expect seamless reimbursements in larger amounts.
For more information about patient eligibility criteria, please visit ECP & EECP Patient Guidelines