Increasingly common in work compensation surgical procedures, dozens of new spinal implants are approved by the FDA each month. This highly variable and difficult to manager cost driver requires an acute focus and real-time market intelligence to appropriately mitigate rising costs.
Pain management represents one of the most challenging segments in workers compensation. Neurostimulators account for the most costly episode of care within the pain management continuum. Market demand, facility acquisition costs, and billed charge amounts continue to rise year over year.
Often comprised of soft tissue and fixation injuries, orthopedic procedures are the most common surgical occurrence in work related injuries. With the record pace of new product introductions at increasingly higher price points, payers continue to be exposed to this escalating cost driver.
Fusion. The industry's premier implant cost management solution.
Traditional bill review processes largely apply only the very basic review and reduction edits when implants are involved. This is widely due to a lack of experience and specific knowledge related to the actual product acquisition costs, procedure level billing details, and the inability to defend more reasonable reimbursement reductions associated with these types of surgical billings. Provider billing practices and multifaceted state regulations exacerbate the problem. As such, most claims are subject to arbitrary valuations leading to significant overpayment and financial waste.
ForeSight provides these additional savings by applying years of very specific experience, a dynamic database of market-level implant acquisition information, and first hand insight into abusive billing practices that go relatively unchecked today.
Foresight’s precise reduction methodologies ensure each and every audit is performed with diligence and clarity. Foresight prides itself on the communication and defensibility of our reductions and therefore takes complete financial and administrative responsibility for provider disputes and legal costs associated with defense of our implantable audits.
Objectivity is at the forefront of everything we do. Foresight’s foundation of implant industry expertise, combined with decades of comprehensive data, analytics, and a proprietary—modular based bill adjudication platform, allow us to deliver the most concise implant cost mitigation strategies in the industry.
ForeSight’s commitment to clear and comprehensive provider communication is a core component of our operating philosophy. Every audit Foresight performs includes a supplementary provider communication document that outlines the exact manner in which our reimbursement recommendation was determined. Our commitment to clarity and open communication minimizes network disruption, provider disputes and administrative burden on claims professionals.