TMS was FDA cleared in the United States in 2008 although it wasn’t until 2016 that most all insurance companies began to cover TMS.
This is great news, Only if you know how to prove medical necessity and what barriers to expect from insurance payers.
Here are some tips to make your TMS business more efficient and profitable.
* Contract with as a many major PPO Insurance payers as you can.
* Once contracted, know exactly what their reimbursements are on the three TMS codes.
* Also know what the medical necessity requirements are to clear your patient for treatment
* You will also need to staff and train according to their coverage policies.
And finally but most importantly, make sure that you have the right back office staff for this business. It is not easy to clear a patient for TMS coverage. Your staff will need to have the drive and tenacity to “figure it out” and “follow it through”.
Here are a few medical necessity denial elements you will want to expect and be prepared to answer to.
*How long is too long for a “current depressive episode”.
*If your client is recently sober, some insurance companies will want to see 6 months of sobriety before clearing for TMS.
*What kind, for how long and with whom has your client been in therapy.
*What other diagnosis has your client had that may interfere with clearance.
We hope our information helps as you journey to being a successful TMS provider!
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