The concepts that DRG’s are wrong and soon will be gone are both wrong
The first sections of this blog are devoted to giving owners “a heads up”. Some understanding into why they must personally check for vulnerabilities. A defense against future take back looses. I do stress owners. Normally organized and funded O &P billing departments are usually too overwhelmed with routine matters to correctly perform this almost foreign duty. If Routine denials are often neglected, how can you expect anticipation for the future?
Medicare and all insurances are struggling to keep their clientele invoicing in line with actual inflation.
To achieve this correctness of reimbursements has become critical. Their most used recourse is to demand a paper trail designed to be quickly understandable to them. They are achieving this on a often trial and error basis. Reformulating their paperwork demands on a rapid basis. However due to personnel training shortfalls they are often not able to take advantage of these published revisions immediately. If you as an owner do not stay current with these published but not enforced demands you immediately become vulnerable to possibly unrecoverable future take backs.
To begin you must check all paperwork you are now submitting against format, nomenclature, notes, dating, referencing, and signature demands. Electronic signatures must be properly dwelt with. Do not expect a billing clerk to do this for you unless you want to spend a lot on overtime. It takes a lot of careful and painstaking work. Many of these changes have happened within the past year be certain you are using the most recent criteria. For the future do not expect them to spot new changes it is not an immediate problem. This blog will be drawing attention to areas of concern but checking it out is your responsibility. It’s your money, your responsibility, your future red flag.
We will be calling owners to get feedback and suggestions of concerns please take the call we definitely will try to make it worth your while.