Armando Javier Colón Aponte MSCJ, CBMA, COC, CASCC, CPPM,CFWAP, CWHBP, PCAP™’s Post

Why is an ortho-focused RCM partner better for independent orthopedic providers? After all, most other billing companies work across all specialties. What's the difference? Not that we're on our way to the American Alliance of Orthopaedic Executives (AAOE) conference or anything 😏 Some people say a claim is a claim is a claim. Just bill em all! Sure, at the end of the day we're all using the same forms, the same data fields, just with different codes and numbers. But to assume they're all basically the same...that's almost like saying a patient is a patient is a patient 😮. Each encounter is a personal experience for provider and patient, and the best billing reflects that. Knowing patient journeys in depth means better pattern recognition and better error detection. Can you bill an injection with an office visit? What's billable in the global period? Let's talk about PCM. We know RCM isn't just churning out claims, it's looking for specialty-specific opportunities. Some people say what really matters is knowing the *payors*. Sure, you can get better billing performance by knowing UMR will ask for records every time, or that...hypothetically...Anthem will pretend that Carelon never gave them the auth number 🙉 , or a thousand other little things. Those are true across specialties. But keeping a bead on how the medical policies meet the patient journey and how those change every year takes real depth in a specialty and a willingness to invest in specialized knowledge. How do you get Aetna to pay for a meniscectomy, after all? Who's covering Zilretta, Euflexxa, Durolane? The more you see these situations, the better prepared you can be. Some people say they never hear from their billing company, and they don't know who's on their account 😒. Ultimately we're committed to working closely with providers, clinical teams, and yes, Orthopedic Executives. That's all made a lot easier when we speak the same language and understand the pressures on this specialty specifically. Patients in pain, covering call at the hospital, investments in robotic surgery, private equity, ASCs, and so much more in the background to our conversations about billing. Getting better billing performance requires an efficient billing engine, but that's no longer enough. Tight partnership to search and destroy denials, educate the front desk, and improve documentation takes it to the next level. See you in Chicago!

Master the secrets to maximizing your ASC's profitability with seven expert strategies. Learn how to reduce costs, optimize OR utilization, and leverage technology for financial health. Whether you're managing supply chains or improving revenue collection, these insights will help your ambulatory surgery center thrive. Don't miss out on these game-changing tips!

Quick Guide to CPT Modifier 58, 59, 78, 79, 24 Modifiers 58, 78, 59, 79, and 24 are CPT modifiers applied to surgery claims. They each have very specific, though related definitions. They often cause confusion, especially between modifiers 58 and 78, but also among 59, 79, and even 24. Here are the definitions, according to Current Procedural Terminology (CPT): ✓ Modifier 58 Definition: “Staged or related procedure or service by the same physician during the post-operative period.” ✓ Modifier 78 Definition: “Unplanned return to the operating or procedure room by the same physician following initial procedure for a related procedure during the post-operative period.” ✓ Modifier 79 Definition: “Unrelated procedure or service by the same physician during a post-operative period.” ✓ Modifier 59 Definition: “Distinct Procedural Service: Under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-E/M services performed on the same day…” ✓ Modifier 24 Definition: “Unrelated E/M service by the same physician during a post-operative period” Knowing when to choose modifier 58 over 78 or 79 over 78 is vital. Why? Using the wrong modifier can mean denied claims. The different modifiers also carry varying reimbursement schemes. For instance, Modifiers 59 and 78 can reduce Medicare reimbursement below 100%. • Modifier 58 and modifier 78 are often mixed up, because both refer to related procedures by the same physician in the post-operative period. However, modifier 58 generally describes staged/planned procedures, while modifier 78 is used for unexpected procedures. • Modifiers 59 and 79 can be confused as well. Both can refer to unrelated procedures by the same physician. However, 79 focuses on the post-operative period, while 59 centers more specifically around same-day or same-session procedures. • Finally, modifier 24 covers only E/M services by the same physician during the post-op period. • Billing with the right modifiers means less denied claims and higher reimbursement. That means health care workers can ultimately save money for employers. The decision tree below aims to simplify the choice between modifiers 58, 78, 79, and 59.

Master the secrets to maximizing your ASC's profitability with seven expert strategies. Learn how to reduce costs, optimize OR utilization, and leverage technology for financial health. Whether managing supply chains or improving revenue collection, these insights will help your ambulatory surgery center thrive.

The impact of implant pricing on Ambulatory Surgery Centers (ASCs) is a critical challenge affecting profitability. Surgeon alignment at ASCs has led to a substantial reduction in screw prices, emphasizing the need for effective implant cost management without compromising patient care quality. Device Management Companies (DMCs) like Evolent (formerly IPG) play a crucial role in addressing this issue. They leverage contract negotiation, data analytics, and industry relationships to optimize implant costs and revenue cycle management for ASCs. DMCs negotiate favorable pricing, optimize payer contracts, facilitate value-based care models, and provide data-driven insights. Internal strategies are also essential for ASCs, such as strengthening surgeon collaboration, enhancing cost management, and diversifying payer mix. A collaborative approach involving ASCs, surgeons, device manufacturers, payers, and DMCs is key to managing implant costs effectively and ensuring financial sustainability while delivering high-quality patient care. Exploring specific aspects like the role of value-based contracting or challenges in negotiating with device manufacturers can provide deeper insights into optimizing implant costs in ASCs. #theDNAofCostOptimization #ASCsCostEffective #DeviceManagement

United Healthcare extends vertical integration with acquisitions of outpatient surgery centers... astute way to benefit from growth in outpatient procedures, and interesting move to capture an even bigger slice of the healthcare pie https://lnkd.in/dYRYbUyx

Consider adding ASC’s to your call pattern. Here are some reasons for medical distributors to consider adding surgery center-focused products: *Growing Demand: Ambulatory Surgery Centers (ASCs) are seeing a significant increase in demand as more patients seek cost-effective, outpatient surgical options. *Revenue Diversification: Adding ASC-focused products helps distributors diversify their revenue streams by targeting a rapidly expanding market segment. *Higher Margins: ASC-focused products often come with higher margins compared to standard medical supplies, as ASCs tend to prioritize quality and efficiency for better patient outcomes. *Less Bureaucracy: Unlike hospitals, ASCs typically have streamlined procurement processes, allowing distributors to establish relationships and close sales faster. *Long-Term Partnerships: ASCs often form long-term relationships with trusted distributors, providing recurring revenue opportunities for products that need regular replenishment. *Growing Physician Ownership: Many ASCs are physician-owned, which can create strong incentives for quality products and foster loyal relationships with reliable distributors. *Focus on Specialized Products: ASCs usually focus on specific types of procedures, giving distributors an opportunity to introduce specialized products that align with these niches and further differentiate their offerings. Contact me to get started. [email protected]

💼 Deciphering the Complexity: Orthopedic Billing Unveiled 🛠️💰 Orthopedic billing stands at the intersection of intricate medical procedures and complex reimbursement systems, presenting unique challenges for providers and billing professionals alike. Here's why orthopedic billing is often considered one of the most complex areas in medical billing: 🔍 Diverse Procedures: Orthopedic practices encompass a wide range of procedures, from routine consultations and diagnostic tests to intricate surgeries and post-operative care. Each procedure requires meticulous documentation and coding to accurately reflect the services provided. 💡 Coding Complexity: Orthopedic procedures are often intricate and multifaceted, making coding a challenging task. With numerous CPT codes, modifiers, and documentation requirements specific to orthopedics, ensuring accurate coding and compliance with regulatory standards is paramount. 📝 Documentation Requirements: Orthopedic billing relies heavily on comprehensive documentation to support the medical necessity of services rendered. Detailed documentation of diagnoses, treatment plans, surgical procedures, and post-operative care is essential for successful reimbursement. 💼 Insurance Complexity: Dealing with various insurance plans, each with its own set of rules, fee schedules, and prior authorization requirements, adds another layer of complexity to orthopedic billing. Navigating insurance contracts, claims processing, and denials management requires expertise and attention to detail. 💻 Technology Integration: Orthopedic practices often utilize advanced technology for imaging, surgical procedures, and rehabilitation. Integrating these technologies with billing systems and electronic health records (EHR) demands seamless interoperability to ensure accurate billing and coding for both procedures and DME items. Despite these complexities, mastering orthopedic billing is essential for ensuring proper reimbursement, optimizing revenue cycle management, and maintaining compliance with regulatory standards. By leveraging expertise, advanced technology, and strategic workflows, orthopedic practices can navigate the complexities of billing with confidence and efficiency. 💪💼 #OrthopedicBilling #MedicalCoding #HealthcareRevenueCycle 🚀

As PE's push into medical specialties continues, firms are grappling with how to keep practitioners motivated, aligned and loyal. Chicago-based DuneGlass Capital's solution: Everyone gets paid out at the same time and same multiple at exit. #Cardiology #Healthcare #OralSurgery