Obtaining consent for a Total Knee Arthroplasty (TKA) surgery

PUBLISHED ON March 01, 2021
As presented by:

Dr. John Svirbely, MD Chief Medical Informatics Officer (CMIO)
and Denis Gagné, CEO & CTO at Trisotech.

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Automated Guidelines for Healthcare Reimbursement Series

Part 3: Documentation of Medical Necessity for CMS Home

Recorded on November 18, 2020
As presented by:

John Svirbely, CMIO and Denis Gagné, CEO & CTO at Trisotech

Audits for medical necessity can be a headache and a financial burden to providers. Problems are often traced to issues such as incomplete documentation and incorrect coding. In this third webinar, we will demonstrate how business models can be used to meet Centers for Medicare and Medicaid Services (CMS) rules for home health care. These models can serve as documentation, especially when supported by decision models for disease severity and therapeutic decision-making. In addition, the models can schedule renewals when needed, reducing interruptions in patient care.

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Automated Guidelines for Healthcare Reimbursement Series

Part 2: Preauthorization for Targeted Drug Therapy and Streamlining of the Appeals

Recorded on October 21, 2020
As presented by:

John Svirbely, CMIO and Denis Gagné, CEO & CTO at Trisotech

Targeted drug therapy can be very expensive, and insurance companies do not want to pay for it when it is not indicated. In the second webinar, we will discuss preauthorization for targeted drug therapy using Rituximab as an example. We will show how business models can streamline the appeals process for both the insurer and the provider. Analysis of the data can give insights that can result in process improvements.

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Automated Guidelines for Healthcare Reimbursement Series

Part 1: Orthopedic Surgery Preauthorization

Recorded on September 30, 2020
As presented by:

John Sviberly, CMIO and Denis Gagné, CEO & CTO at Trisotech

Preauthorization can be a source of stress for patients and providers. It is difficult to keep up with the changes made by different insurers, and there is the threat of criminal prosecution. In the first webinar, we will give an example of a routine preauthorization for an orthopedic surgical procedure – first total knee arthroplasty. The burden for providers can be reduced by integrating preauthorization with models used to prepare the patient for surgery.

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