Slide 1: Intracept Patient Access Portal Training
Intracept Patient Access Portal Training NM-2134811-AB 1
Slide 2: Patient Access Portal Platform Background
Patient Access Portal Platform Background • The in-house Patient Access Program (AP) of Boston Scientific is offered on behalf of patients, not providers. The AP assists patients in obtaining access to care, navigating the process with their insurers, and helps promote Intracept with payors as a min
Slide 3: Intracept Patient Access Program Process Overview
Intracept Patient Access Program Process Overview For the Intracept Procedure: Patient Identified by Provider/APP: - Review procedure - Review authorization process - Obtain signed HIPAA authorization form 3
Slide 4: The Intracept Procedure
The Intracept Procedure 1 2 • Same-day surgery, brief recovery • Implant free • Preserves overall spine structure • Long-term pain relief after single Access the Pedicle Create the Channel treatment (mean follow-up of 6.4 years)1-3 3 4 • Reduced utilization of injections 3 • Proven safety profile4 I
Slide 5: Diagnostic Coding
Diagnostic Coding Diagnosis Codes for the Intracept Procedure: ICD-10 Description M54.51 Vertebrogenic low back pain; low back pain vertebral endplate pain M54.50 Low back pain M54.9 Dorsalgia, unspecified M47.816 Spondylosis w/o myelopathy or radiculopathy, lumbar region M47.817 Spondylosis w/o mye
Slide 6: Reimbursement
Reimbursement * Rates above are Medicare national averages subject to geographic adjustment. Commercial rates are generally higher than Medicare and dependent on contracted rates. 6
Slide 7: Dedicated Reimbursement Support
Dedicated Reimbursement Support Patient Access Team Payer Strategy & Health Policy Team • Works to obtain access to care (prior authorization) for • Pursues positive coverage with payers your patients • Develops tools & resources to help patients & customers • Not outsourced – over 41 full-time BSC
Slide 8: Commercial Payer Patient Access Process
Commercial Payer Patient Access Process Facilitating Patient Access If If Submit Prior Denied 1st and 2nd Level Appeal Denied Independent Review Authorization Setting proper expectations is the key to satisfaction: • IntraceptTM is still considered Investigational and Experimental (I&E) with half of
Slide 9: Payer Decisions Timelines
Payer Decisions Timelines P2P – 15 days Initial < 30 days 45 days Hearing 90 days Request Appeals L1/L2 – 20-45 IRO days • Commercial cases can go up to IRO (4 months) (Self-funded have an employer review option) • Medicare Advantage cases can go up to ALJ Hearing (4-6 months) • Medicaid cases can g
Slide 10: Traditional Medicare Patient Access Process
Traditional Medicare Patient Access Process Courtesy clinical reviews for traditional Medicare are ONLY offered for physicians who have recently completed IntraceptTM training. • Traditional Medicare patients in a state without an active Intracept LCD, can be entered into the portal for the first 30
Slide 11: Medicare Advantage Patient Access Process
Medicare Advantage Patient Access Process Facilitating Patient Access If If Independent Review If Administrative Submit Prior Denied by Medicare Denied Denied 1st Level Appeal Law Judge (ALJ) Authorization Contractor (Maximus Federal) Hearing Setting proper expectations is the key to satisfaction: •
Slide 12: Secondary Insurance Plans
Secondary Insurance Plans Types of secondary insurance plans • Full commercial plans (i.e., employer sponsored) - may need prior authorization • Medicare Supplement (i.e., plan N, F or G) - does not need prior authorization • ChampVA - does not need prior authorization and covers • Medicaid – there
Slide 13: Portal Case Entry Overview
Portal Case Entry Overview 13
Slide 14: Upload Requirements for Prior Auth or Medicare Review
Upload Requirements for Prior Auth or Medicare Review 1 • Provided by Boston Scientific Patient Authorization Form (Consent) • Every portal patient must sign and date this form • Keep this form accessible • Mention or description of Modic type I or II changes Other descriptors include: Active Schmor
Slide 15: Intracept Patient Intake Form
Intracept Patient Intake Form The Intake form for use can be found HERE. 15
Slide 16: Cognitive Behavioral Therapy Resource
Cognitive Behavioral Therapy Resource Some IntraceptTM payer coverage policies require the patient to participate in cognitive behavioral therapy (CBT). We have identified a resource that can provide CBT services via telehealth for the patient’s convenience. Advantage Point Behavioral accepts and is
Slide 17: Entering a Case
Boston, Scientific Entering a Case
Slide 18: Login to Portal
Login to Portal Go to: bsci.my.site.com/NMDPreAuthPortal to login 18
Slide 19: Portal Home Page
Portal Home Page Visit My settings to update The "Home" tab allows for creation of personal information and a new pre-auth request. preferences. 19
Slide 20: Portal Home Page, con’t
Portal Home Page, con’t Open the "Cases" tab to display a drop-down menu with four list view options. 20
Slide 21: Portal Home Page, con’t
Portal Home Page, con’t "Drafts" allows for storage of cases in progress that are awaiting additional information before they can be submitted. 21
Slide 22: Documenting the Pre-Auth Form
Documenting the Pre-Auth Form From Home tab, click “Create New Request” to begin entering a new case. The Pre-Auth Form template will be initiated. For Intracept, choose 'Basivertebral Nerve Ablation (Intracept)' as "Therapy Type" and click, “Save & Next”. 22
Slide 23: Documenting the Pre-Auth Form, con’t
Documenting the Pre-Auth Form, con’t Enter patient information into all required fields. NOTE: • Patient email is very important, please obtain if possible. Remember: When Intracept is the Therapy Type and Anthem is the insurance, be sure to choose ‘Anthem’, and not Anthem broken down by state. This
Slide 24: Documenting the Pre-Auth Form, con’t
Documenting the Pre-Auth Form, con’t M54.51 is the most specific diagnosis code for vertebrogenic pain. Select primary ICD code and secondary ICD code (if applicable), click “Save & Next”. Complete Physician & Facility information, click “Save & Next”. NOTE: Only approved Physicians and Facilities a
Slide 25: Documenting the Pre-Auth Form, con’t
Documenting the Pre-Auth Form, con’t Enter any patient specific notes if applicable Upload required information or documentation Uploaded documents will be displayed here 25
Slide 26: Save as Draft
Save as Draft If not ready to "Submit", option to "Save as Draft" while waiting for missing information 26
Slide 27: Save as Draft, con’t
Save as Draft, con’t Updates (Edit, Delete, Manage Files, New Notes) can be made at any time when in "Draft" status. Click the Pending Items "Pencil" to open an area that can be used to keep track of missing documentation. IMPORTANT A case saved as 'Draft' is only visible to the practice/portal coor
Slide 28: Save as Draft, con’t
Save as Draft, con’t When the case is ready for final review, click "Edit" while in "Draft" status to be taken to the original interface. Page through all tabs to ensure accuracy, then click "Submit" button. 28
Slide 29: Save as Draft, con’t
Save as Draft, con’t When submitted, the new case record automatically displays. For future follow up, navigate to the correct case through the "Cases" tab. NOTE: Use the comment box for case manager / portal coordinator communication Please @ the Case Owner with any updates. If the Case Owner is no
Slide 30: Communication and Scheduling Approved Patients
Communication and Scheduling Approved Patients COMMUNICATION: APPROVALS: • Notification emails are sent to the Practice and • Authorizations: Patient with important status updates, such as approvals, denials, and requests for additional • Are specific to a SoS and physician information. • Have an ex
Slide 31: Friendly Reminders
Friendly Reminders • Access to Care services are provided to patients seeking treatment with the IntraceptTM Procedure. Authorization services are not provided for patients being treated with another basivertebral nerve ablation system. • Obtaining the patient’s email is critical to our ability to c
Slide 32: Resources
Resources • For any questions related to post-service claim denials, authorizations obtained outside the Intracept portal, payer contracting/reimbursement for Intracept, or physician documentation improvement, please contact your Reimbursement Business Manager. • For any questions or issues related
Slide 33: You are ready to enter your first case!
You are ready to enter your first case! 33
Slide 34: Indications For Use and Disclaimers
Indications For Use and Disclaimers View Boston Scientific Intracept Intraosseous Nerve Ablation System Indications, Safety, and Warnings at bostonscientific.com/intracept- indications Disclaimer: Health economic and reimbursement information provided by Boston Scientific Corporation is gathered fro