Dramatic medical advances in implantable medical devices within the last 20 years have allowed people to maintain more active, productive lives as they grow older. However, these advances have come at a tremendous financial cost, as both the devices and the procedures to implant them are very expensive. Sales of implantable devices in the United States reached $20 billion in 2008, and are expected to reach $37 billion annually by 2013. Healthcare payers bear the majority of the financial burden in covering the costs for these services.

Many health payers cover implantable devices through contractual carve-outs with hospitals, while the related surgical procedures, hospital stays and other services are often paid separately based on Diagnosis Related Groups, per diems or global case rates. This complicated mix of payment methodologies and billing procedures, combined with the need to pay claims quickly, has resulted in healthcare payers often significantly overpaying claims for these services.

We help payers to efficiently identify, recover, and prevent overpayments on implantable device claims, by creating customized Implantable Audit Programs that can include some or all of the following services:

Our Implantable Audit Program always flags and reports any systemic overpayments identified, so our clients can take action to prevent them in the future.