Roundtable 1: Best Practices for Managing Escalating Surgical Implant Costs

While surgical implants are designed to be discreet and invisible for patients, for payers, implant costs can have a very noticeable impact on spending. Many health plans overpay for surgical implants due to lack of true cost transparency, national price variations, and incorrect billing for non-implantable items. The amount paid by health plans is often significantly higher than the provider’s true acquisition cost, equating to markups of 1,000% or more at times.

While off-the-shelf bill review solutions identify some savings, not all solutions are created equal. Comprehensive programs where the bill review process is managed end-to-end by industry experts and that are backed by the most up-to-date facility-specific implant cost data have been independently validated to deliver consistently greater savings.

Join this roundtable discussion to learn best practices for managing your surgical implant costs. We will cover what to look for when selecting a payment integrity partner to generate maximum cost savings, how to ensure durable and defensible savings that hold up through reconsiderations, and Paradigm’s industry-leading results. 

The roundtable will be hosted by Matt Ruyter, Senior Director of Product from Paradigm. Paradigm has reviewed over $2.3 billion in total implant charges, resulting in hundreds of millions of dollars of savings for our clients.

Roundtable 2: Silos, Garbage, and Dominoes: Bridging the COB Disconnect

Alan Coulter will explain the history of how the payment integrity and revenue cycle issues with Coordination of Benefits began, provide examples of current problems, and what downstream impacts can occur if COB issues are not addressed at the member, group, and claims level for both payers and providers. He will also provide some tips for healthcare insurance companies wishing to maximize their processes to assist their provider partners and vice versa when caring for patients with multiple coverages.

The session uses a case study to demonstrate the value of tracking audit, appeal, and overturn success rates. Lessons learned from audit response methods will be reviewed to highlight successful strategies in the early stages of the review process. Actionable and practical steps will be incorporated to illustrate how various stages of the audit and appeal process can be managed.