Issue link: https://beckershealthcare.uberflip.com/i/1094308
59 HEALTHCARE NEWS so your coders can link each patient's procedure to the proper contract to ensure that they are coding correctly and billing appropriately--and that your ASC ultimately gets paid exactly what it is due. 8: Understand that the financial stakes are high. Implants used in total joint replacement surgeries are expensive. e average implant cost for total joint surgeries is several thousands dollars each, which is 5 to 10 times more than the average implant for other less complex procedures. is is why coding mistakes can have a significant impact on revenue. 9: Be ready to justify your efforts. Because total joint procedures are expensive, you need to be ready to supply medical records to payers as requested. Indeed, payers oen will want to ensure that patients received an MRI or other imaging tests and participated in more conservative treatments, such as physical therapy, be- fore undergoing surgery. Authorized personnel should be able to comply with such medical record transfers in a timely manner. 10: Utilize a patient financial counselor. A financial counselor can help patients see the financial advantages associated with having a procedure performed in an ASC versus in the hospital. For example, a counselor may evaluate a patient's benefits and find that it would cost them nearly double to have the same procedure performed in a hospital rather than in an ASC. e financial counselor can also explain the other tremen- dous benefits of an ASC, such as personalized attention, ease and flexibility of surgery scheduling, and lower infection rates. With such powerful data in front of them, patients are more likely to feel good about mak- ing informed decisions. 11: Put your patient advocate hat on. Make sure your registration packets include an appeal authorization form. is form allows your ASC to make an appeal on the patient's behalf if the payer doesn't offer the agreed upon payment to avoid burdening the patient if pay- ment disputes arise. Minimizing the patient's personal involvement in such disputes has a significant impact on patient satisfaction. 12: Use a fine-toothed comb to review financial perfor- mance. Because total joint surgeries are big ticket items, it is important to conduct a monthly audit to ensure that each procedure was coded, billed and paid cor- rectly. If you uncover any discrepancies, find where the mistake originated and then file an appeal if warranted. Pay particularly close attention to implant billing, since implants are expensive items that could represent 25% to 30% of your overall total joint surgery reimburse- ment and payment for them is closely tied to very specific contract stipulations. Remember, your center is required to buy these implants upfront. is means if you are not paid correctly, your ASC will take a direct out-of-pocket loss. In the final analysis, those ASCs that have done the work up front will be well-positioned to reap the significant financial rewards of total joint surgeries migrating from hospitals to ASCs. n Top execs of America's 5 largest commercial health plans By Morgan Haefner Here are the leaders of the five insurers with the most members and revenue in 2018, listed alphabetically: 1. Gail K. Boudreaux, president and CEO of Anthem. Ms. Bou- dreaux became president and CEO of Anthem in 2017. She was formerly CEO of UnitedHealthcare, the health insurance division of UnitedHealth Group. 2. Bruce D. Broussard, president and CEO of Humana. Bruce Broussard joined Humana in 2011. He served as CEO of McKes- son Specialty/US Oncology before beginning at Humana. 3. David Cordani, president and CEO of Cigna. Mr. Cordani be- gan serving as Cigna's president and CEO in 2009. He joined the company in 1991 from Coopers & Lybrand, which later merged with Price Waterhouse to become PwC. 4. Karen S. Lynch, executive vice president of CVS Health and president of Aetna Business Unit. After CVS Health completed its acquisition of Aetna, Ms. Lynch became executive vice presi- dent of CVS Health and president of Aetna. Before joining CVS, she served as president of Aetna. 5. David S. Wichmann, CEO of UnitedHealth Group. Mr. Wichmann became CEO of UnitedHealth in 2017. Prior to that role, he served as president of UnitedHealth beginning in November 2014, and CFO of the company from 2011 until mid-2016. n Walmart drops price of virtual visits from $40 to $4 By Emily Rappleye W almart is offering employees a 90 percent discount on telemedicine, dropping the price of a virtual visit from $40 to $4, The Denver Post reports. The retailer reduced the cost of telemedicine services Jan. 1 to increase options for employees seeking care, a spokesperson confirmed to Becker's Hospital Review. Walmart's health benefits currently cover more than 1 million people enrolled it its Associ- ates' Medical Plan. Through this plan, virtual visits through the Doctor On Demand app are covered like a normal physician's office visit. Walmart is one of many employers to offer telemedicine ben- efits to workers. Eighty percent of large and midsize companies offered the benefit in 2018, according to the report. However, factors like emotion, forgetfulness and preference have kept uti- lization down. Just 8 percent of employees at large and midsize companies used telemedicine benefits in 2017, according to the report. n