Respond to EGID implant invoice and audit requests within 30 days

Provide the actual invoice(s) for any implant billed when requested by EGID. During audits EGID may also request documentation showing discounts not listed on the invoice and an item-to-claim mapping identifying which implants on an invoice apply to the audited claim. The IHO must submit requested invoices and documentation within 30 days of EGID's request. If EGID's audit finds billing above acquisition cost, the IHO must refund any overpayments and provide invoices for subsequent claims prior to payment; continued noncompliance or failure to supply requested invoices within the required timeframe may result in EGID no longer allowing separate reimbursement for implants.

• EGID requires the actual invoice for the implant billed upon request.
• EGID may conduct quarterly retrospective audits of implant charges.
• During an audit, EGID will request invoices for audited claims and documentation of discounts not listed on the invoice.
• IHO has 30 days to submit requested information to EGID.
• If audits find billing above acquisition cost the IHO must refund overpayments and provide invoices for subsequent claims prior to payment.
• Failure to timely provide invoices or continued billing above acquisition cost can result in loss of separate implant reimbursement.

Bill implants at net invoice cost and use descriptive CPT/HCPCS (or unlisted code with explanation)

Bill implants at invoice (net) acquisition cost less any rebates or discounts, using the most descriptive CPT/HCPCS code available. If no specific CPT/HCPCS code exists for an implant, bill with the appropriate unlisted CPT/HCPCS code and include an explanation of each item and corresponding charge. Include prorated shipping, handling, and tax for the billed implant when invoices include other supplies.

• Bill implants at invoice cost less any rebates and/or discounts received by the Facility.
• Use the most descriptive CPT/HCPCS code; if none exists, use an appropriate unlisted CPT/HCPCS with an itemized explanation and charge.
• EGID will allow up to the net cost, including prorated shipping, handling, and tax when applicable.

Bill bundled services per the Select Fee Schedule; apply bilateral, emergency, and code-combination rules

Follow Select Fee Schedule billing rules for bundled services: bill the codes specified on the schedule, apply the Select Allowable Fee, and treat all services on the bundled service date as inclusive of the Bundled Allowable Fee. Bilateral procedures are reimbursed at 150% of the Select Allowable Fee. Emergency services are not eligible for bundled payment. If a CPT/HCPCS billed is considered part of a more comprehensive code billed the same date, only the more comprehensive code is covered unless the Select Fee Schedule specifies otherwise. EGID will review and update fee schedules quarterly or as needed.

• Bill codes as specified on the Select Fee Schedule; a list of CPT/HCPCS codes and Allowable Fees is on the EGID website.
• All services on the date of the bundled procedure are included in the Bundled Allowable Fee.
• Bilateral procedures reimbursed at 150% of the Select Allowable Fee.
• Emergency services are excluded from bundled payment eligibility.
• If a billed code is part of a more comprehensive code billed the same date, only the more comprehensive code is covered unless noted on the Select Fee Schedule.
• EGID reviews and updates fee schedules quarterly or as needed.
• For High Deductible Health Plan members, EGID will reduce payment by any member deductible owed.