Handling insurance authorization and reimbursement for HFCWO

prescription_reimburse_prescribe_smartvestAs part of its commitment to customer care, Electromed, Inc., manufacturer of the SmartVest® Airway Clearance System, employs an experienced Reimbursement Team. The team handles the submission of authorization and reimbursement forms, plus ongoing coordination and communication with insurance payers, relieving prescribing physicians and their staffs of those tasks.

Because Electromed has years of experience working collaboratively with payers on authorization and reimbursement for high frequency chest wall oscillation (HFCWO), clinicians, patients and caregivers typically value having Electromed specialists manage the process. Here’s how that process typically works with a private insurer:

Prescribing the SmartVest System by Electromed

Physicians who prescribe HFCWO find it advantageous to view Electromed as an extension of their medical and office staffs when it comes to navigating reimbursement and coordinating with insurers.

When a physician writes a prescription for the SmartVest System, Electromed first confirms that the patient has active health insurance (including coverage for durable medical equipment) and identifies the patient’s share of the cost (i.e., deductible or co-pay), if any.

If the patient has coverage, Electromed submits a request for authorization to the payer, including details of the patient’s medical status, as provided by the patient’s medical team on the Prescription and Certificate of Medical Necessity form (Rx/CMN). (NOTE: Some payers require that requests for authorization be submitted directly by the physician.)

Prescription forms are available here, along with a sample Rx/CMN form to illustrate its proper completion. The form’s “check-off” format and clearly defined area for physician notes are designed to help insurance providers quickly review the medical rationale and documentation supporting each prescription.