Ken Pettine, MD, co-founder of Colorado's Rocky Mountain Associates in Orthopedic Medicine in Loveland, Colo., discusses five missteps that decrease spine profits in an ASC.
1. Your ASC doesn't authorize the proper procedure upfront. Many procedures require preauthorization from insurers. Your billing team should call the carrier prior to the date of service to make sure the ASC will be reimbursed for the procedure and ask any questions about claims submission.
2. Patient's policy has exclusions or limitations for spine procedures. ASCs must absolutely make sure the patient has coverage before undergoing a procedure. If the patient does not have the required benefits, your claim will be denied and you will lose money.
3. Your implants are not carved out and reimbursed separately. Implant costs can run higher with spine than in traditional orthopedic cases, which means spine implants must be carved out. Implant considerations are critical for profitable spine cases and should be discussed during annual contract negotiations.
4. Proposed codes included in your contract are required to be completed in an inpatient setting. Make sure your spine codes are appropriate for the ASC setting. Otherwise, your physicians should take the cases to the hospital.
5. Cases are scheduled late in the day. Spine cases scheduled late in the day can have a negative effect on staffing costs. "Schedule cases early in the day to give the patient additional time to recover if they are same day cases," Dr. Pettine says. "[That way], they do not require an overnight stay, [meaning] you have to call in a night shift." If you schedule spine cases early in the day, surgeons will still be able to complete a case that becomes unexpectedly difficult.
Learn more about Rocky Mountain Associates in Orthopedic Medicine.
Read more advice on spine in ASCs:
-8 Reimbursement and Business Concepts for Spine
-Study: New Protocol Nearly Eliminates Infection in Spinal Surgery Patients
-10 Established Best Practices for Increasing Spine Surgery Profits
1. Your ASC doesn't authorize the proper procedure upfront. Many procedures require preauthorization from insurers. Your billing team should call the carrier prior to the date of service to make sure the ASC will be reimbursed for the procedure and ask any questions about claims submission.
2. Patient's policy has exclusions or limitations for spine procedures. ASCs must absolutely make sure the patient has coverage before undergoing a procedure. If the patient does not have the required benefits, your claim will be denied and you will lose money.
3. Your implants are not carved out and reimbursed separately. Implant costs can run higher with spine than in traditional orthopedic cases, which means spine implants must be carved out. Implant considerations are critical for profitable spine cases and should be discussed during annual contract negotiations.
4. Proposed codes included in your contract are required to be completed in an inpatient setting. Make sure your spine codes are appropriate for the ASC setting. Otherwise, your physicians should take the cases to the hospital.
5. Cases are scheduled late in the day. Spine cases scheduled late in the day can have a negative effect on staffing costs. "Schedule cases early in the day to give the patient additional time to recover if they are same day cases," Dr. Pettine says. "[That way], they do not require an overnight stay, [meaning] you have to call in a night shift." If you schedule spine cases early in the day, surgeons will still be able to complete a case that becomes unexpectedly difficult.
Learn more about Rocky Mountain Associates in Orthopedic Medicine.
Read more advice on spine in ASCs:
-8 Reimbursement and Business Concepts for Spine
-Study: New Protocol Nearly Eliminates Infection in Spinal Surgery Patients
-10 Established Best Practices for Increasing Spine Surgery Profits