The SVS maintains expertise in payer policies and seeks to answer questions and assist SVS members who are experiencing issues with private payors (private insurance companies). These issues could include lack of coverage, prior authorization, reimbursement support, surprise billing, network adequacy, narrow networks, tiering, or others.
In addition, the SVS monitors payment changes within Medicare. In these settings, most decisions about what procedures will be covered under Medicare are made by local contractors and are known as local coverage determinations (LCDs). In some cases, the Centers for Medicare & Medicaid Services decides that a coverage issue is national in scope and it issues a national coverage determination (NCD).
The SVS Coding Committee has a payer relations section that addresses issues with payers (Medicare and private insurers). Members can send in their concern, along with documentation (i.e. policies, denials, letters, etc) and the coding committee will review the issue. Depending on the issue and the potential impact on SVS membership, the SVS Coding Committee will advocate for change with the payer.
Want SVS to review an issue? Submit your issue, with documentation (such as copies of policies and or denial letters and appeal letters with identifying information redacted) below.