Question Answers/Format Do you have immediate postpartum Have not started protocols and process flows in place for Working on it implants? In place departments have implemented a L&D protocol to support immediate postpartum Postpartum unit placement of implants? (check all that OB OR apply) (Check both "L&D" and "Postpartum Pharmacy unit" if hospital has combined Billing L&D/postpartum unit.) Other: _____________ Hospital has coding/billing strategies in for reimbursement for IPLARC If your hospital carries LARC devices, does Hospital is not eligible for/doesn’t participate in 340B your hospital use 340B purchasing for LARC Eligible, not yet participating devices? Eligible, participating Do not know Have you implemented billing for Haven’t started IUDs? Working on it In place Have you implemented billing codes for Haven’t started implants? Working on it In If billing codes are implemented for IUD, Traditional Medicaid/Medicaid FFS implant, or both, with which payers do you Medicaid MCOs have billing strategies in place? Private insurers (please specify, check all that apply) Ambetter Assurant Health BCBS of IL Coventry Harken Health Humana United Health ____________ Has your hospital billed for the devices you Yes placed? No Not yet placed any devices Have you received reimbursement for the Yes, traditional Medicaid/Medicaid FFS devices that you placed? (check all that Yes, from MCO(s) apply) Yes, from at least 1 Medicaid MCO Yes, from all Medicaid MCOs with whom the hospital contracts Yes, from all Medicaid MCOs, even those with whom the hospital does not contract Yes, from private payer(s) Yes, from at least 1 private payers Yes, from all private payers with whom the hospital contracts No Not yet placed any devices
Question Answers/Format Do you have immediate postpartum protocols and process flows in place for implants? Have not started Working on it In place departments have implemented a protocol to support immediate postpartum placement of implants? (check all that apply) (Check both "L&D" and "Postpartum unit" if hospital has combined L&D/postpartum unit.) L&D Postpartum unit OB OR Pharmacy Billing Other: _____________ Hospital has coding/billing strategies in for reimbursement for IPLARC If your hospital carries LARC devices, does your hospital use 340B purchasing for LARC devices? Hospital is not eligible for/doesn’t participate in 340B Eligible, not yet participating Eligible, participating Do not know Have you implemented billing for IUDs? Haven’t started Working on it In place Have you implemented billing codes for implants? Haven’t started Working on it In If billing codes are implemented for IUD, implant, or both, with which payers do you have billing strategies in place? Traditional Medicaid/Medicaid FFS Medicaid MCOs Private insurers (please specify, check all that apply) Ambetter Assurant Health BCBS of IL Coventry Harken Health Humana United Health ____________ Has your hospital billed for the devices you placed? Yes No Not yet placed any devices Have you received reimbursement for the devices that you placed? (check all that apply) Yes, traditional Medicaid/Medicaid FFS Yes, from MCO(s) Yes, from at least 1 Medicaid MCO Yes, from all Medicaid MCOs with whom the hospital contracts Yes, from all Medicaid MCOs, even those with whom the hospital does not contract Yes, from private payer(s) Yes, from at least 1 private payers Yes, from all private payers with whom the hospital contracts No Not yet placed any devices
ILPQC%20IPLARC%20Data%20Form_Paper%20Version_FINAL_8.20.18.docx