Common Spravato Billing Issues Faced by Practices Today

Common Spravato Billing Issues Faced by Practices Today

The scope of this article is to shed some light into how Spravato billing issues has affected many healthcare providers in pursuing Spravato therapy at their practice. Spravato nasal spray was approved by FDA just recently for clinical use in adult treatment resistant depression and suicidal ideations. Though deemed infamous for potential chances of abuse, this drug is widely agreed on its promising efficacy and impact. It gives hope to millions of patients and their care providers. 

Researches are still going on to gather more information regarding the long-term safety and efficacy of the drug. And healthcare providers and insurance companies are yet to resolve the ongoing Spravato billing issues. Let us look at a few possible hurdles practices face in handing Spravato therapy.

A mere office -based psychiatry clinic cannot administer Spravato to the patients. It has to be equipped for psychopharmacological interventions which also facilitates inhouse monitoring of patients at an REM setting. The practice should have the means to store and dispense Spravato, which also points to a special DEA license to adopt Spravato practice. This includes knowledge in everything about dose, duration and administration of Spravato under supervision.

A major one among all the Spravato billing issues is its preauthorization requirements. Spravato is made available to those health care providers who are eligible to prescribe it by undergoing a training on the risks and importance of risk evaluation and management strategy. This requires both the patient and the healthcare provider to fill up a patient enrolment form which proves the patient as an eligible candidate to receive Spravato. A patient must have tried at least two different antidepressant drugs from two different classes to be eligible to receive Spravato according to the authorities. If the patient enrolment is not done right from the provider’s part, there is every chance the patient will be tagged ineligible for the drug. 

For Spravato, the clinicians need to purchase the drug first and then get it reimbursed later which is known as the buy and bill method of reimbursement. This upfront cost has turned out to be quite unaffordable to most healthcare providers. According to the clinicians, they are not used to buying a controlled substance for storing at their practice. Keeping inventory for such an expensive medication and having to wait for reimbursement to get paid is one of those Spravato billing issues

Since Spravato is administered by risk evaluation and mitigation strategy, healthcare providers are advised to bill for the evaluation and monitoring phase of treatment as well. But at this point, the code for treatment an observation time is not specifically derived which is quite disappointing. The insurance companies are reluctant to cover the extended observation period rendered from the part of the provider, which is not a cost -effective scenario on the provider’s front.

For the healthcare providers, the mechanism of Spravato has proven itself with a fresh approach to depression disorders. Yet, all these Spravato billing issues are limiting the patient’s access to this amazing drug to a great extent. With the right help from experienced billers in the industry, healthcare providers can easily find success with Spravato practice.