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How this orthopedic ASC prevents prior authorization surprises

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While some ASC administrators have hired extra staff to handle prior authorizations, Andrew Lovewell, administrator at Columbia, Mo.-based Surgical Center at Columbia Orthopaedic Group, has kept those duties in house.

Mr. Lovewell told Becker's ASC Review his center's strategies as an orthopedic ASC.

Note: This response was lightly edited for style.

Question: How do you estimate prior authorization will affect revenue at your center?

Andrew Lovewell: As an ASC that specializes in musculoskeletal and orthopedic care, prior authorization is extremely important to us. At the Surgical Center at Columbia Orthopaedic Group, we are early adopters of a lot of technology enhancements and cutting-edge implants. However, sometimes being progressive creates challenges with insurance companies not being up to speed with the latest technologies or coding guidelines.

We have a robust and impressive business office that has extremely good leadership. What is different about us versus many other facilities, is we keep everything in house. Prior authorization and insurance verification are all done on-site by our staff so we can control the patient experience. We are extremely hands-on with the physicians that send cases and patients that have surgery here. This results in us not having surprises with case denials postsurgery, and it prepares patients well in advance of surgery to know what they will owe. Our business office manager is very involved in this process, and she often works in insurance, collections and every aspect of our back-end shop to assure that things go smoothly and all areas are supported well.

As an ASC that specializes in the care we do, we have very unique challenges with authorizations regarding high-cost implants and procedures. It is integral to our business that we obtain the prior authorization and communicate with the physicians to assure that we have every detail or possible detail specified prior to surgery to avoid any postsurgical billing complications.

 

 

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