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PATIENT
CARE
REIMBURSEMENT
AND FINANCIAL
AMBUSCAN
SERVICES
Q:
Which patients could benefit from
an Ambulatory EEG test?
A:
The
diagnostic advantages of Ambulatory EEG are well documented.
There is no question that obtaining a recording over a prolonged
period of time enhances the ability to capture an abnormality or an
event. Couple this with the advantage of collecting this
information while the patient resides in his own environment, and
the advantages increase tenfold.
Recent
advances in technology have made Ambulatory EEG an unparalleled
resource providing information in the documentation, investigation,
and ongoing therapeutic planning for patients with seizure
disorders. Some of the indications are as follows:
-
Documentation
of seizure by type, frequency, and severity
-
Documentation
of sub-clinical seizures
-
Differential
diagnosis of seizure vs. syncope
-
Differential
diagnosis of seizure vs. pseudo-seizure
-
Differential
diagnosis of seizure vs. behavior manifestations
-
Differential
diagnosis in psychiatric disorders
-
Evaluation
of efficacy of anticonvulsant therapy
-
Evaluation
of efficacy of Ketogenic Diet therapy
-
Pre-screening
prior to removal from anticonvulsants
-
Pre-
and post-surgical screening of Vagal Nerve Stimulator
-
Pre-
and post-surgical screening for epilepsy surgery
Q:
How
long is a typical Ambulatory EEG study?
A:
There
is no rule that limits an Ambulatory EEG study to 24-hours.
Valuable information can be gained by recording for periods up to
72-hours. Further, advances in technology make this possible
without battery changes or any other maintenance.
Q:
How
has technology improved Ambulatory EEG testing?
A:
Recent
advances in technology have effectively addresses most, if not all,
of the past disadvantages of Ambulatory EEG testing. Recorders now
collect up to 36-channels of data for as long as 72-hours, without
battery changes or any other maintenance. Amplifier technology is
far more advanced with sampling rates and data resolution equal to
or better than most lab based EEG machines. Data collection
techniques have been refined to substantially reduce
non-physiological artifact. The result is lab-quality EEG recordings
that can be quickly and accurately reviewed, just as you would read
a routine EEG.
Q:
What is Medicare's
coverage policy for Ambulatory EEG studies?
A:
You should first refer to your
state's Local Medical Review Policies (LMRP) for local guidelines on
establishing medical necessity; however, there are currently very
few published for Ambulatory EEG. In the absence of an LMRP,
you should refer to the National Coverage Determination (NCD) for
documenting the medical necessity of this procedure.
NATIONAL
COVERAGE DETERMINATION (NCD)
An
NCD sets forth whether Medicare will cover, or not cover, specific
services, procedures, or technologies on a national basis. Medicare
contractors are required to follow NCDs. If an NCD does not
specifically exclude an indication or circumstance, or if the item
or service is not mentioned at all in an NCD or in a Medicare
manual, it is up to the Medicare contractor to make the coverage
decision
The
following information can be found in detail in the Medicare
Coverage Issues Manual at the Center
for Medicare & Medicaid Services website:
NCD
for Ambulatory Electroencephalographic (EEG) Monitoring (Effective
for services performed on or after June 12, 1984) (50-39.1)
Indications
and Limitations of Coverage
Ambulatory
EEG monitoring is a diagnostic procedure for patients in whom a
seizure diathesis is suspected but not defined by history, physical
or resting EEG. Ambulatory EEG can be utilized in the differential
diagnosis of syncope and transient ischemic attacks if not
elucidated by conventional studies. Ambulatory EEG should always be
preceded by a resting EEG.
Ambulatory
EEG monitoring is considered an established technique and covered
under Medicare for the above purposes.
Q:
What
CPT Codes are used for Ambulatory EEG billing?
A:
The following CPT Codes are used for billing Ambulatory EEG studies:
| 95953 |
Monitoring
for localization of cerebral seizure focus by computerized
portable 16 or more channel EEG, electroencephalographic (EEG)
recording and interpretation, each 24 hours |
$370
- $1500 |
| 95957 |
Digital
analysis of electroencephalogram (EEG) (e.g., for epileptic
spike analysis) |
$150
- $300 |
Q:
What is the typical
reimbursement for an Ambulatory EEG study?
A:
Medicare reimbursement rates range from $370-$475 per 24-hour
period (95953), plus approximately $150 for digital analysis
(95957), depending on where your practice is located. The
private payer range is from the Medicate rate of $370 to over $1200
per 24-hour period in some areas.
Using
Medicare as a conservative financial guideline, one can expect $890
- $1000 reimbursement per 48-hour Ambulatory EEG study.
Please
consult with your billing expert to verify the revenue opportunity
in your particular situation.
Q:
How many patients do
I need each month for this to make good business sense?
A:
AmbuScan programs are extremely flexible offering plans that make
"good business sense" at any patient volume. Please
see our Services Page or contact
us to find a plan that is right for your practice.
Q:
The hospital does AEEGs. Why should I consider doing this in my
office?
A:
Until the introduction of AmbuScan,
Ambulatory EEG tests were not commonly done in the private practice.
Traditionally, a group needed to do at least ten 24-hour studies per
month to justify hiring a full-time Registered EEG Technologist. And
even at this high patient volume, the cost of the tech made the
venture a "break-even" at best.
With
AmbuScan you can keep this profitable procedure in your private
practice, without hiring a full-time tech, and without buying your
own AEEG equipment. You will also be able to bill the global
fee for doing the same work you do today, resulting in substantially more revenue per procedure. Plus, you can bill an additional
$300 per test for the digital analysis of the data collected.
Below is a comparison of income
streams from patients tested in the hospital and in a private
practice utilizing AmbuScan services:
The chart above is for example only.
You should consult with your billing experts to verify the revenue
opportunity in your particular situation. The estimates presented
are based on 2003 Ohio Medicare Fee Schedule rates. Your individual
opportunity may be greater or less than the numbers presented here.
By
doing the procedure in your office you can substantially increase
your income per procedure on every test you do. Further, you
will maintain complete control over your patient's care, and your
patient will not have the hassles typically associated with a
hospital visit.
Q:
Why should I use
AmbuScan services instead of hiring my own tech?
A:
Considering salary alone, your break-even to employ a full-time
R.EEGT. is eight to ten 24-hour studies every month. Factor in
equipment and other costs, and an office would need to do about 12
to 14 studies every month to be profitable.
Utilizing
AmbuScan services and equipment, only two 48-hour studies per month
would generate nearly $15,000 in annual net revenue. Four studies would
generate approximately $40,000 in annual net revenue without any capital
outlay, and without any recruiting, hiring, and managing of a
qualified technologist.
Q:
How
is an AmbuScan study scanned?
A:
AmbuScan studies are first digitally analyzed by a computer using
Persyst Reveal software. Sophisticated algorithms are used to
identify potential seizure activity, then the software marks these
epochs enabling easy review and validation of the results.
After digitally scanning the study, a
Register EEG Technologist "plays" the study at high speed with audio
designed to help further identify and mark potential abnormalities.
The record is then ready for the R.
EEG T. to visually scan. First, our technologist reviews the
areas identified in the first two steps to validate the information.
Then they review the entire record to confirm nothing has been
missed, paying special attention to abnormalities, patient events,
and periods corresponding to patient journal entries.
Once the record is completely scanned
and marked by our technologist, we "clip" out the areas of interest
along with at least 5 minutes per hour of normal EEG. The
result is a much smaller file for the physician to review, with all
questionable data highlighted along with some background EEG.
The full study is left in tact and is
returned to the physician along with the edited copy.
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