46
ADVERTISINGINDEX
Note: Ad page number(s) given in parentheses
ADVERTISER
ASCOA.
development@ascoa.com / www.ascoa.com / (866) 982-7262 (pg. 20)
Bioventus Surgical.
cssurgical@bioventusglobal.com / www.bioventussurgical.com / (919) 474-6700 (pg. 42)
Centinel Spine.
cs@centinelspine.com / laterval.centinelspine.com / (484) 887-8810 (pg. 2)
eSutures.
info@esutures.com / www.esutures.com / (888) 416-2409 (pg. 38)
Globus Medical.
www.globusmedical.com/kinexplus / (610) 930-1800 (pg. 5)
Joimax.
info@joimaxusa.com / www.joimaxusa.com / (pg. 42)
L3 Healthcare Design, Inc.
www.l3asc.com / (866) 929-5353 (pg. 31)
National Medical Billing Services.
info@nationalascbilling.com / www.nationalascbilling.com / (636) 273-6711 (p. 17)
Orthofix.
comments@orthofix.com / www.orthofix.com / (888) 298-5700 (pgs. 7, 48)
Pinnacle Spine.
www.pinnaclespinegroup.com/gap / (214) 466-1428 (pg. 47)
Spineguard.
www.spineguard.com / (415) 512-2500 (pg. 40)
Xenco Medical.
sales@xencomedical.com / www.xencomedical.com / (858) 202-1505 (pg. 11)
Xodus Medical.
info@xodusmedical.com / www.xodusmedical.com / (724) 337-5500 (p. 13)
Spine Surgery Coverage Denials Cost Surgeons $191k: 5 Key
Notes
By Laura Dyrda
T
he International Society for the Advancement of
Spine Surgery released results from a study about
how a third-party payer's delay or preauthorization
coverage denial can impact spine practices.
ISASS sent a 14-question survey to 571 spine surgeons
about their perceptions of third party payers' delay or deni-
al for preauthorization coverage and payment. There were
115 surgeons who responded with an annual case volume
ranging from 50 cases to 700 cases; the average was 300
cases.
More than half — 51 percent — of the cases were lumbar
surgeries; 35.9 percent were cervical surgeries. Most of the
respondents were orthopedic spine surgeons — 67 percent
— while the remaining were neurosurgeons.
Here are five key findings from the survey:
1. A majority — 84.3 percent — said insurance denials led
to unfilled operating room time. By comparison, 11.8
percent reported patient medical issues and 10.8 percent
reported office/hospital inefficiencies as the culprit for
unfilled OR time.
2. Around one-fourth of the cases were denied during the
preauthorization process, but 58.5 percent of the cases
were denied three days or fewer before surgery.
3. Of the denials, 72.7 percent reported lumbar spine sur-
gery denials; 21.4 percent reported cervical spine surgery
denials.
4. Around 24 percent of the cases yielded reduced
payments despite preauthorizations; another 9.4 percent
weren't paid despite the preauthorization.
5. The calculated total potential in lost revenue was
$191,250 based on Medicare reimbursement for instru-
mented and non-instrumented cases. The researchers
calculated the total potential lost revenue for physicians
with average 300 case volume and the 25 percent denial
rate, equaling 75 lost cases.
"Surgeon perceptions of insurance and pre-authorization
delays and denials have a significant negative impact
on surgical scheduling and the efficient utilization of
OR block time," concluded the study authors. "Further,
respondents indicated surgery preauthorization does not
lead to appropriate reimbursement in approximately one-
third of the cases." n