Outpatient Total Joint Replacements: Billing Best Practices

1
(No Transcript)
2
Outpatient Total Joint Replacements Billing Best
Practices

• Did you know?
• According to recent statistics, the demand for
  outpatient joint replacements is steadily rising,
  with an estimated 55 increase in procedures
  performed outside hospitals in the last decade.
• This shift is largely driven by advancements in
  surgical techniques, improved anesthesia options,
  and the desire for quicker recovery times.
  However, dealing with complex ASC billing and
  reimbursement operations in outpatient settings
  can be challenging.
• Thats why were here to provide you with
  easy-to-understand insights and practical tips to
  optimize your billing practices and ensure smooth
  financial operations for outpatient total joint
  replacement procedures. Lets dive in!
• Read Detailed Blog _at_ https//www.247medicalbilling
  services.com/blog/outpatient-total-joint-replaceme
  nts-billing/

 https//www.247medicalbillingservices.com
 info_at_247medicalbillingservices.c
om
3
Outpatient Total Joint Replacements Billing Best
Practices

• Outpatient Total Joint Replacements Best Billing
  Practices
• Outpatient total joint replacement surgeries are
  gaining popularity in ambulatory surgery centers
  (ASCs), adding an opportunity for maximizing
  reimbursement. However, there is a need to adopt
  the best billing practices to deal with the
  ever-evolving rules and regulations, and
  complexities in ASC billing and coding. Some of
  the best billing practices include
• In-Network vs. Out-of-Network Strategy
• ASCs must decide whether to go in-network or stay
  out-of-network for total joint replacements.
  While out-of-network contracts may offer
  flexibility initially, transitioning to
  in-network status can lead to long-term benefits.
  In-network agreements typically result in higher
  reimbursement rates and lower patient
  responsibilities, enhancing financial outcomes
  for ASCs.

 https//www.247medicalbillingservices.com
 info_at_247medicalbillingservices.c
om
4
Outpatient Total Joint Replacements Billing Best
Practices

• Data Collection
• Prior to negotiations, ASCs must gather data on
  processes, procedures, and outcomes to
  demonstrate the success and cost-effectiveness of
  total joint replacements. This includes
  historical data on patient outcomes, cost savings
  compared to traditional hospital settings, and
  evidence-based guidelines for patient selection.
  Data-driven presentations strengthen ASCs
  bargaining position and justify higher
  reimbursement rates.
• Comparative Price and Cost Savings Analysis
• Insurance companies are under pressure to reduce
  healthcare costs, making cost-saving data crucial
  during negotiations. ASCs should compare their
  pricing with local hospitals and emphasize cost
  efficiencies achieved through the ASC setting.
  Demonstrating significant cost savings for payors
  enhances the chances of favorable reimbursement
  terms.
• Justifying Higher Costs
• If ASCs are perceived as more expensive than
  competitors, they must justify these higher costs
  to payors. There are numerous factors, such as
  superior outcomes, quicker recovery times, and
  minimized additional medical needs, that can
  support higher reimbursement rates. By
  highlighting the value proposition, ASCs can
  negotiate favorable margins despite higher costs.

 https//www.247medicalbillingservices.com
 info_at_247medicalbillingservices.c
om
5
Outpatient Total Joint Replacements Billing Best
Practices

• Negotiating Implant Reimbursement
• Implants constitute a significant expense in
  total joint replacements. ASCs should negotiate
  with insurers to ensure implant reimbursement is
  included in overall procedure costs. In fact,
  there is a need to provide detailed information
  on implant choices, costs, and authorization
  procedures to strengthen reimbursement
  negotiations and ensure financial viability for
  ASCs.
• Establishing Dialogue with Insurers
• Building ongoing communication with insurers
  fosters a collaborative relationship and
  facilitates smoother contract negotiations.
  Understanding payors preferences and structuring
  negotiations accordingly enhances mutual
  understanding and strengthens reimbursement
  agreements.
• Addressing Perceptual Challenges
• In markets where insurers remain hesitant to
  accept total joint replacements in outpatient
  settings, ASCs must address perception
  challenges. Utilizing data from national
  associations and local facilities, along with
  surgeon expertise, can educate insurers on the
  safety and efficacy of outpatient total joint
  replacements. Not only this but the focus should
  be highlighting evidence-based clinical practice
  guidelines to reinforce the feasibility of these
  procedures in ASCs.

 https//www.247medicalbillingservices.com
 info_at_247medicalbillingservices.c
om
6
Outpatient Total Joint Replacements Billing Best
Practices

• Facility Showcase and Education
• Inviting insurers to tour the ASC and observe
  total joint replacement procedures firsthand can
  alleviate skepticism and build confidence in the
  facilitys capabilities. Demonstrating suitable
  patient candidates, safety protocols, and
  successful outcomes during facility tours
  enhances insurers understanding and support for
  outpatient total joint replacements.
• Understanding Reimbursement Limitations
• ASCs must be aware of regulatory and insurer
  guidelines regarding reimbursement limitations
  for total joint replacements. Medicare rules and
  commercial insurer policies indicate specific
  criteria for reimbursement, including time
  limitations for patient stays and restrictions on
  post-surgery rehabilitation facility
  reimbursements.

 https//www.247medicalbillingservices.com
 info_at_247medicalbillingservices.c
om
7
Outpatient Total Joint Replacements Billing Best
Practices

• Outsourcing to 24/7 Medical Billing Services
• Outsourcing can be one of the beneficial billing
  practices for ASCs performing outpatient total
  joint replacements. In fact, ASCs can streamline
  revenue cycle management and improve financial
  outcomes by outsourcing ASC billing and
  collections to the experts. By leveraging these
  professional companies expertise, efficiency,
  and technology, ASCs can optimize reimbursement,
  achieve cost savings, focus on core competencies,
  and mitigate compliance risks.
• Not only this but 24/7 Medical Billing Services
  typically operate on a fee-based model, allowing
  ASCs to control and predict billing expenses more
  effectively. Cost savings from outsourcing can be
  reinvested into enhancing patient care, facility
  infrastructure, or other strategic initiatives.
  Therefore, ASCs can leverage their efficiency to
  maximize revenue and minimize denials or
  rejections, ultimately optimizing reimbursement
  for total joint replacements.

 https//www.247medicalbillingservices.com
 info_at_247medicalbillingservices.c
om
8
Connect with an Expert Coding Company!

• Though there are many medical billing and coding
  service providers in the market, one need to find
  an expert in urology billing to boost the
  practices revenue cycle. 24/7 Medical Billing
  Services is one such knowledgeable partner in the
  field of urology billing and coding. They have a
  dedicated urology coding staff with the latest
  billing software for urology practice. Any
  urology practice can boost its revenue and
  improve patient care by collaborating with 24/7
  Medical Billing Services.
• 24/7 Medical Billing Services is the nations
  leading medical billing service provider catering
  services to more than 43 specialties across the
  entire 50 states. You can rely on us for
  end-to-end revenue cycle management. We guarantee
  up to 10-20 increase in the revenue with cost
  reduction of your practice for up to 50.
• Call us today at 888-502-0537 to know more on how
  we can help boost profitability for your
  practice.

 https//www.247medicalbillingservices.com
 info_at_247medicalbillingservices.c
om
 https//www.247medicalbillingservices.com
 info_at_247medicalbillingservices.c
om
9
Call us Today
Media Contact 24/7 Medical Billing
Services, 28405 Osborn Road, Cleveland, OH,
44140 Tel [phone] Email
info_at_247medicalbillingservices.com Website
https//www.247medicalbillingservices.com/