document everything.
"Authorization is the primary hurdle," says
Ms. Mishler. "The secret to successful reim-
bursement is to be proactive at the point of
prior authorization."
Dr. McMillan recommends having a contin-
gency plan in place as well. "All planned pro-
cedures must be preauthorized with claim ref-
erence numbers provided," he says. But, he
notes, insurers like to point out that preautho-
rization doesn't guarantee payment, so it's
also important to have legally enforceable
patient guarantees when claims are denied.
The guarantees, he says, must specify that the
patient knows exactly what the charges and
the insurance contractual write-off are, and
patients must authorize an alternate source of
payment.
Patient selection
Of course, not every patient with back pain is
a candidate for surgery. "Patient selection is
tremendously important, especially in the
start-up phase," says Mr. Hood. "Be conserva-
tive, have established selection criteria and
stick to them." A holistic approach that
includes pain management and the option to
provide conservative treatment before, after,
and sometimes instead of, surgery, is an inte-
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