Wiki Cigna Reimbursement policy

[Sentry2018]

Hi,
Is anyone having issues where Cigna is saying they paid the facility for neuromonitoring services? We bring in our own technician who is employed by the company and our own equipment to the facility (which we own as well). The facility does not provide any of our services, yet they are telling us they paid the facility which is WRONG.

Can anyone help with this on what to do in situations when they say go fetch your money from the facility? We are an out of network provider as well.

Anything helps.

 

[CodingKing]

Its a facility expense regardless of who provides it. You need to seek reimbursement from the hospital for it.

 

[thomas7331]

Agreed, all technical services are a component of the facility fee. The case rates that most insurance companies negotiate and pay to facility are inclusive of all services except professional fees. If the facility is using your technician's services and equipment and allowing them on the premises during a procedure, then you should seek a contract with the facility and obtain reimbursement from them. The same thing would apply if, for example, a provider's office sent their ultrasound technician to a facility that did not have its own, or if the facility sent specimens out to a lab because it was not able to process them in-house.

 

[jglang5]

Agree. The facility reimbursement includes the technical portion so you should negotiate with the hospital for a case rate. You should still bill the payer for the professional portion though, on codes where that concept applies.