Heller Associates, Inc., is a third party administrator headquartered in Costa Mesa, California, with an additional office located just outside Cleveland in Chesterland, Ohio. The company’s 40+ employees approach each client’s plan by providing brokers and employers with analysis of plan data, summation of trends, benefit alternatives and human resource assistance. Heller Associates concentrates on the specific needs of each client, allowing the company to build a complete quality and cost-efficient program suited to the plan sponsor’s objectives.

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In recent years, advancement in operative procedures and improved instrumentation technology has caused costs for spinal surgeries to skyrocket. Spine surgery, such as lumbar fusions and scoliosis surgery is common and costly. The physician billing for these surgeries is very complex and, frequently, inappropriately coded. The physician-friendly coding errors, if undetected, result in substantial overpayments to physicians.

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HCC Benefits is proud to offer an easy and efficient way to transfer medical precertification data for Utilization and Review Vendors who provide stop loss reporting. We have developed a common file format for importing precertification data and notes directly to our system. Files are imported in their entirety to include all hospital admissions, and our system electronically flags catastrophic diagnoses, trigger procedure codes (ex. hemodialysis, craniotomy, transplants, etc.), lengthy in-patient stays and multiple admissions that could pose a potential stop loss risk for review.

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In discussing the issue of identifying drug dispensing and appropriate cost, discussion turns to the confusion over tracking drug use in medical claims adjudicated by Medicare "J" coding. J codes are assigned to drugs that can be injected subcutaneously, intramuscularly, or intravenously. The exception to this ruling is oral immunosuppressive drugs, which may be billed via J codes.

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Dan Strusz serves as the Regional Vice President of the Midwest Region based in Plymouth, Minn. He began with HCC Benefits in November 2001 as Regional Underwriting Manager, but was recently promoted subsequent to the appointment of Larry Stewart to Chief Underwriting Officer in the corporate office in Kennesaw, Ga. This well-deserved promotion follows more than 20 years in the industry working for a third party administrator, a managing general underwriter and two carriers, holding various underwriting and management positions along the way.

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